The Reclamation Intake Form

Thank you for taking the time to complete this form. I will review your responses and look forward to meeting you soon.

Sharing this info helps me understand you better and ensures our sessions are helpful for you.

Your answers will remain confidential and will not be shared with any third party.

What inspired you to explore The Reclamation at this time?

Feel free to share what called you to this experience or what aspects of the process spoke to you.

What areas of disconnection, imbalance, or curiosity are currently present for you; physically, emotionally, or energetically; in relation to your body, creativity, or sense of inner feminine power?

(For example: pelvic tension, emotional heaviness, creative blocks, numbness, grief, disconnection, or something else entirely.)

Have you experienced any past experiences; physical, emotional, or energetic; that may have impacted your relationship with your body, feminine energy, or creative center?

(This may include trauma, loss, pain, or any other challenges you feel are important to name.)

If yes, please share any details you feel comfortable discussing:

What are your intentions for this reclamation session?

E.g., releasing stored emotions, deepening your connection with your inner wisdom, awakening creative energy, etc.

Have you previously participated in any body-based, intuitive, or energy healing practices?

(This may include womb work, breathwork, Reiki, somatic therapy, or other healing experiences—feel free to share anything that feels relevant.)

If yes, please briefly describe your previous experiences:

Do you have any current health conditions or physical limitations that I should be aware of?

Please detail any relevant information to ensure a safe and supportive session.

Is there anything else you’d like to share about your journey or your goals for this healing experience?

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The Reclamation Intake Form

Thank you!