Soul recalibration intake form

Miscarriage

Abortion

Stillborn

Infant Loss of death

Separation or estrangement from a child

Unresolved pregnancy or child experience

Not sure how to describe it

I function well but feel something unresolved

I feel emotionally disconnected or numb

I feel tension or holding in my body

I feel guilt, heaviness, or quiet grief

I feel intellectually at peace but not fully settled

I don’t feel distressed, but feel unfinished

Mostly calm and stable

Generally okay with emotional waves

Often tense or shut down

Currently feeling fragile

I function well but feel something unresolved

I feel emotionally disconnected or numb

feel tension or holding in my body

I feel guilt, heaviness, or quiet grief

I feel intellectually at peace but not fully settled

I don’t feel distressed, but feel unfinished

Mostly calm and stable

Generally okay, with emotional waves

Often tense or shut down

Currently feeling fragile

Panic attacks

Dissociation

Suicidal thoughts

Severe depression

Recent crisis or trauma

Non of the above

I understand this is a complementary, body-led session and not a replacement for medical or psychological care.

I understand I remain in control at all times during the session.

I understand outcomes are not guaranteed.