Intake form | Souling Ceremonial

First name

Last name

Date of Session

Phone

Email

General Information

Have you ever done breathwork before? If yes, what type and how was your experience?

What called you to book this session?

What would you like to receive or release during this session?

Do you have a spiritual or self-care practice? If yes, what does it look like?

Medical + Emotional History

Are you currently taking any medications? If yes, please list them.

Do you have a therapist, counselor, or support system in place?

Is there anything else you'd like me to know to support your safety and depth in this session?

Consent

I understand that breathwork can bring up strong physical and emotional experiences. I take full responsibility for my own well-being and understand that this session is not a substitute for medical or psychological care.

Signature

Date

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