Fertile Ground Intake Form
Thank you for your interest in the Fertile Ground Program! Please take the time to fill out this intake form to get clear on intentions and goals for the program. Thank you! - Sylvia
Sign in to Google to save your progress. Learn more
Email *
Name *

What are you hoping to get out of being in this program? List 3 INNER transformations and 3 OUTER results.

For example: (Inner) I would feel more at peace in the fertility journey. (Outer) I would be eating healthy and consciously preparing my body for pregnancy.
Which area are you most seeking support in?  *

Out of all of the above, what are the top 3 areas you'd like to work on? Please share details of your situation.


If you could wave a magic wand and those issues were addressed, what would life look like five weeks from now?


If you had that transformation, how would you feel? What would be possible for you?

What do you think is holding you back from having already achieved this transformation?
Why is now the time to focus on this transformation?

On a scale of 1-10 how important is it to you to grow in these areas in the coming months?

Not Important
Extremely Important
Clear selection

Which of my modalities are you open to / curious about?


What are your fears or aversions to being in this group? Or groups in general?

What do you enjoy about group containers?
What would help you feel safe in a group?
When you picture being in the Fertile Ground group program, what are the images of healing and transformative that come to mind?
Anything else that you would like to share at this time?
Thank you for taking the time to fill out the intake form! -Sylvia
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wisdom Heart Healing. Report Abuse