Form cover
Page 1 of 1

Energetic Intake Form for Private Sessions

Welcome to your next chapter. This form is the first step toward working together. Your answers help me tune into your energy and ensure we are aligned for the journey ahead.

Website: Inherfrequencies.com
Contact Email: [email protected]

Basic Details

What's your full name?

What's your date of birth?

Location (City + Time Zone)

Email

Phone Number

Session Interest

Which service are you most interested in?

Which service are you most interested in?
A
B
C
D

Energetic Readiness

These questions are meant to help me understand where you are in your journey—not to judge, but to tune in.

In your own words, why do you feel called to this work right now?

How does your mind naturally process the world around you?

(This will help me tailor your induction and support your journey more intuitively. Select all that apply)

How does your mind naturally process the world around you?

Have you experienced any form of hypnosis or deep meditation before?

Have you experienced any form of hypnosis or deep meditation before?
A
B

If you replied yes above, please give a brief explanation if possible.

Are you currently navigating any physical or mental health challenges, trauma, or grief?

Are you currently navigating any physical or mental health challenges, trauma, or grief?
A
B

If you replied yes above, you can give a brief explanation if you feel called to. It is completely optional.

Are you currently taking any medications? If so, you can list them. If not, just type NO below.

To ensure alignment and transparency, which of the following investment ranges are you currently comfortable with for a session?

✦ Please Note:

As part of my QHHT and SCHH practitioner certification, these sessions are being offered free of charge for a limited time. However, to honor the time and energy held for you, I do require a refundable deposit to secure your session—$55 for QHHT and $44 for SCHH. This will be returned in full within 24 hours after your session unless you feel called to let it stand as a gift in gratitude. This structure protects the integrity of the work and ensures that this sacred time is treated with reverence.

To ensure alignment and transparency, which of the following investment ranges are you currently comfortable with for a session?
A
B
C
D
E
(Note: This does not commit you to a booking — it simply helps me understand where you are in your journey.)

Is there anything you're hoping to release, discover, or remember through this session?

Alignment Check

What do you value most in a healing experience?

What do you value most in a healing experience?
A
B
C
D

If you could design your ideal healing space, what would it feel like?

(This helps me prepare a space that feels safe and aligned for you specifically.)

Prompt:

When you imagine entering a space that feels comforting, grounding, and open for deep healing—what does that space look and feel like to you?

Would you feel most at ease just sitting in a comfy couch? Lounging on floor cushions? Do you prefer cozy blankets, soft lighting, or ambient sounds?

Share anything that would help me prepare a space that feels sacred for you.

Are you open to receiving intuitive guidance, messages from your higher self, or past life recall as part of your session?

Are you open to receiving intuitive guidance, messages from your higher self, or past life recall as part of your session?
A
B
*If you are unsure of your answer, please check out the website a bit more (Inherfrequencies.com), that will give you a good idea of whether any of these services is meant for you at this time. And if you have further questions, you can always email or send me a DM!

Is there anything I should know about your energy, belief system, or background that will help me serve you better?

Is there anything else you’d like to share with me before I review your form?