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Reclamation & Becoming| Client Intake Form

Welcome to Reclamation & Becoming.

This is where we begin. Your answers will help me prepare your natal
chart diagnostic and shape our work across the coming year.

You do not need to know anything about astrology. Answer from where
you are now, not where you think you should be. You can keep any
answer brief, and we will explore the important details together.

Full Name

Email

Preferred name or nick name.

Date of Birth

Exact Birth City, State, or Region and Contry

Exact Birth Time

Morning or evening?

A
B

What prompted you to begin this work now?

What decision, transition, or recurring pattern feels most important right now?

Where do you suspect you have been settling, overextending yourself, or leaving yourself out of the equation?

What have you already tried to change, and what happened?

Is there anything about your current circumstances you want me to understand before we begin?

Which areas do you want this year to address?

A
B
C
D
E
F
G

What would you like to be different 12 months from now?

What would meaningful progress look like in the next 90 days?

What are the two or three questions you most want your written diagnostic to address?

What would make our work together feel genuinely useful to you?

What helps you feel supported while doing honest, challenging work?

Is there a way you prefer to receive direct feedback?

Are there any scheduling constraints I should know about for our initial session and quarterly reviews?

Communication and Support

I understand that Reclamation & Becoming is a reflective coaching
experience. Astrological interpretations are tools for exploration,
not predictions or guarantees. I remain responsible for my decisions.

Payment


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