Welcome to Soul Talk your healing journey is just one form away :)

Inner Child Healing Intake Form This space is yours. These questions are designed to gently explore your emotional history so we can better hold space for your healing.

1.Can we get your full name please?

2.What’s your preferred email address?

3.Mobile Number

4.Whats your current city?

5.What’s the best way to reach you?

A

B

Email

C

Phone call

6.How would you like to begin your journey? (please note offline option is currently only available in Bangalore)

A

Group Online

B

Group Offline

C

1 on 1 Healing session

Emotional Check-In

7.Could you briefly tell us about childhood the fond and the painful memories describe as much as you want :)

Time to understand you a little more, You’re welcome to skip anything that feels too much. There is no pressure here-only space.

8.As a child, did you often feel emotionally supported and understood at home?

A

Always

B

Sometimes

C

Rarely

D

Never

9.Were there times in your childhood when the adults around you were too busy, stressed, or unavailable to notice how you were feeling?

A

Yes

B

Sometimes

C

Rarely

D

No

10.Growing up, did you witness or experience any of the following at home? (select any that apply)

Yelling or emotional volatility

Adults who used alcohol, drugs, or were often absent

A caregiver struggling with sadness, anger, or mental health

Divorce or separation of caregivers

Someone close to you being taken away or leaving unexpectedly

Feeling like you had to “keep the peace”

None of these apply

11.Were you ever made to feel "too sensitive" or "too emotional" as a child?

A

Yes, often

B

Occasionally

C

No

12.Which of these patterns show up in your adult life today? (select all that resonate)

I avoid conflict, even when something bothers me deeply

I struggle with self-worth or feeling “not enough”

I feel emotionally overwhelmed by criticism or rejection

I take care of others but forget to care for myself

I disconnect emotionally to feel safe

I find it hard to trust or open up fully

I crave closeness but also fear it

I don’t know what I feel until I break down

13.What does your inner child most need to hear right now? (Optional)

14.What do you hope to reclaim or reconnect with during this program? (Optional )

15.I understand this is not a therapy diagnosis, but a safe emotional exploration. My answers are confidential and shared with care.

I Understand and agree

16.This form helps us understand you better and tailor your experience. It does not replace a clinical diagnosis, and your responses are confidential. Please check to continue.

I understand and agree