New Client Intake Form Please take your time and fill out as much as you feel comfortable sharing. Name * First Name Last Name Email * Phone number * (###) ### #### Date of birth MM DD YYYY Preferred pronouns How did you hear about me? Please tell me about what is drawing you to work with me. In what ways would you like to grow in our work together? How do you practice self-care to feel well physically, mentally, emotionally? Please list any injuries or chronic pain that I should be aware of. What hesitations or edges arise as you step into this work? Do you have any other questions or comments for me? Thank you for completing your intake form. Go ahead and schedule your first session and I will reach out soon.