Empowered to Bloom – Client Intake Form

Welcome!

Thank you for trusting Empowered to Bloom to walk beside you during this sacred season of your journey.

This form is designed to help us begin with intention, clarity, and care.

There are no right or wrong answers — simply share whatever feels true for you.

First name

Last name

Phone

Time Zone

About Your Journey

Which package have you booked?

What called you to this coaching journey at this time?

Long answer

Is there anything specific you would like support with during our sessions?

Long answer

How would you describe where you are emotionally right now?

Preferences for Our Work Together

What type of support feels most nourishing to you?

Gentle space-holding and reflection

Goal-setting and structured guidance

Emotional processing and healing conversations

Mindset support and affirmation building

Practical planning and action steps

Are there any sensitivities, triggers, or emotional topics you would like me to be especially mindful of?

Long answer

Preferred session style:

Final Notes

Is there anything else you’d like me to know before we begin?

Long answer

Gentle Reminder:

Empowered to Bloom offers emotional and mindset coaching. It is not a substitute for medical care, therapy, or clinical mental health treatment. If additional clinical support is needed, I will always honor and support you in seeking it.