top of page

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.


Time Zone

About Your Journey

Which package have you booked?

What called you to this coaching journey at this time?


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


How would you describe where you are emotionally right now?

Preferences for Our Work Together

What type of support feels most nourishing to you?

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


Preferred session style:

Final Notes

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


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.

“Whenever and however you give birth, your experience will impact your emotions, your mind, your body, and your spirit for the rest of your life.” - Ina May Gaskin (Midwife & Birth Advocate)

Copyright 2024 – Website by Ariel

© Empowered to Bloom 2025 | All Rights Reserved             Terms of Use         Privacy Policy
  • Instagram
  • LinkedIn
bottom of page