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Wahkeena Sitka | Intake Form
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Intake Form

To Schedule an Appointment, Please Fill Out the Intake Form and Enclose Your Preferred Times & Days of Availability & Your Location / Time Zone.
Please Note: The * Indicates a Required Field.

Please Describe as Thoroughly as Possible. Thank You!

[contactform email=”” subject=”Soul Muse Session – Intake Form” success=”Thank You! I look forward to Chatting with You Soon!”]

[name label=”Name” required=”true”]
[email label=”Email” required=”true”]
[textfield label=”Website”]
[textfield label=”Phone Number” required=”true”]
[textfield label=”Skype Username”]
[textfield label=”Preferred Days & Times of Availability” required=”true”]
[textfield label=”Location & Time Zone” required=”true”]
[textarea label=”Why are you interested in having a Soul Muse Session with me? What are you looking for?” required=”true”]
[textarea label=”How have you been feeling energetically & emotionally? Please Describe” required=”true”]
[textarea label=”How much Stress have you been feeling recently?”]
[textarea label=”Do you give yourself regular restorative opportunities to Self-Nurture, Relax & Self-Love? If Yes, Please Describe”]
[textarea label=”Do you have any experience with Meditation, Breathwork or Spiritual Practices? If Yes, Please Describe”]
[textarea label=”Do you Exercise, Do Yoga, Dance, Martial Arts, or any other Body-Centered Movement Practice?”]
[textarea label=”Do you Sing, Chant or Enjoy Your Voice? If Not, How do you feel about your voice?”]
[textarea label=”Please Describe any Habitual or Compulsive Addictions You Use”]
[textarea label=”Please Identify and Describe Anything that is Draining or Depleting your Energy.”]
[textarea label=”Do you Love Life? Do you Love Yourself?”]

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