UYP Intake Form
Hey! You're in! This helps me get everything set up for you! Fill this out so I can get your welcome kit on the way and get ready for our first call together.  
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Preferred Name  *
I signed up for: *
Your Birthday <3 *
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Shipping Address (for your oils)  *
What do you do + who do you help? (The more specific you can be in this question, the better!) *
If something could shift tomorrow, what would you most want it to be? *
What do you find yourself overthinking, avoiding, or putting off that would move your business forward?   *
What feels hardest about showing up or being seen on social media right now? *
What feels like it should be easier than it is? *
Six months from now, what do you want to be true about you that isn't true today? *
 Picture yourself 6 months from now... what 3 words describe her?   *
Is there anything in your health history we should be aware of before your sessions? (Things like a pacemaker, blood clotting disorder, or history of seizures; this helps me make sure our group MBSR sessions are safe and effective for you.)   *
I understand that the emotional balancing practices used in this program are intended for maintenance of the best possible state of physical and emotional well being, are never intended to be a replacement for professional counseling / therapy or medical care, and do not involve the diagnosing, treating, or prescribing of remedies for disease. *
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