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Core to Care - Client Intake

Welcome to Core to Care! I'm so glad you're here. This intake form is the first step in our journey together. Your answers help me understand how to best support you as you navigate your postpartum recovery and wellness.

Contact Information

Full Name

Email Address

Phone Number

A Little About Your Journey

How old is your baby? (If you are currently pregnant, please enter N/A)

Are you currently pregnant?

Yes

Estimated Due Date

Briefly describe your birth experience (if you feel comfortable sharing).

Who is part of your current support system?

Current Challenges & Needs

What are your biggest challenges right now?

Sleep

Energy levels

Stress/Anxiety

Physical recovery

Daily routines

Self-care

Returning to work

Household responsibilities

Other

Where are you feeling the need for the most guidance or support?

What, if any, barriers are you facing in your recovery?

What community resources or support networks are you currently using?

Goals & Scheduling

What do you hope to achieve through our coaching sessions?

What does 'success' look like for you in your daily life right now?

What days/times usually work best for our sessions?

Coaching Agreement

Core to Care provides educational and supportive coaching. Please note: I do not provide medical advice, occupational therapy, mental health diagnosis, or treatment. By submitting this form, you acknowledge that you understand the nature of this service.

I agree to the coaching terms above.

Yes, I agree