Luv and Above Client Intake Form

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This short intake allows me to attune to your experience and support you in the most aligned way during your session.

Please answer honestly — your responses are held with care and confidentiality 💛

Email *

Full Name *

Which session are you attending? *

Please add your phone number, if you are ok with occasional text messages

What are you currently experiencing? (You can share anything — stress, tension, emotions, life circumstances, or how your body has been feeling) *

What are you hoping to receive or experience from this session? *

Have you experienced breathwork or similar practices before? *

Yes

Other:

How does your body feel most days? *

Calm and relaxed

Sometimes tense or overwhelmed

Often stressed, anxious, or on edge

I’m not sure

Is there anything important I should be aware of to support you safely?
(This may include physical conditions, injuries, pregnancy, mental health considerations, or anything else you feel is relevant) *

Consent & Acknowledgment

9D breathwork can be a powerful experience that may involve physical sensations or emotional release.

I have read and agree to the liability waiver provided here - Liability Waiver and understand that I am responsible for my own wellbeing during the session.

I understand and agree.

Full Name (Digital Signature)

By typing my full name below, I confirm my agreement to the above.

Send me a copy of my responses.

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