Pre-Session Intake Form

1 — About You

Full Name

Date of Session

How did you hear about my practice?

Intention for today's session What draws you here? What are you hoping to receive?

Area of focus Select all that apply

2 — Health & Sensitivities

Do you have epilepsy or any neurological condition? Required — I use sound and frequency tools in some sessions

No Yes

Do you have any allergies or sensitivities to scents or smoke? Incense, frankincense, essential oils

No Yes — please specify below

If yes, please specify

Are you currently pregnant?

No Yes

Are you currently under the care of a doctor, therapist, or mental health professional?

No Yes

3 — Energetic & Emotional Readiness

Are you currently going through a period of significant emotional stress or upheaval?

No Yes

Have you experienced trauma that may be relevant for me to be aware of? You are not required to share details — a simple yes helps me hold space appropriately

No Yes Prefer not to say

Are there any areas of the body you'd prefer I avoid working around energetically?

No Yes — please specify below

If yes, please specify

Anything else you'd like me to know before we begin?

4 — Spiritual & Cultural Context

Personal spiritual practice or belief system

Cultural or ancestral background relevant to your healing

Have you worked with a tarot reader, reiki practitioner, or energy healer before?

Yes No — first time

5 — Consent & Agreement

Thank you for trusting me with your energy and your story.

Sandy

Arpin

Form Received

Thank you.
I look forward to holding space for you.

See you soon.