Nourishing Conscious Conception + Pregnancy

Nourishing Conscious Conception + Pregnancy
Agreements + Intake
Welcome!
This process is designed to guide you deeper into connection with your own deep inner wisdom, womb, fertility and pregnancy.
It clears the trauma and conditioning stored in our womb space for ourselves, our ancestors, and the collective.
My intention with this journey is to re-awaken your awareness of your own capacity for a well spring of fertiity and prgnancy and ignite an aliveness and softness in your own body and connection with your baby.
I believe in creating relationships and connections on multiple levels: to our bodies, within our relationships, to our own inner wisdom, our own inner child, and our spirit baby(ies).
I offer guidance and insight with the intention that you will hold yourself accountable in your own inner truth and intuition as you begin to walk the path to Matrescence.
Every part of you will be met with acceptance and love.
Coming into this program grants me permission to gently push you past your comfort zone and illuminate the places where you may not be able to see yourself yet.
This isn't about ascending to higher states. This is about bringing those higher states down into your body, into contact with your humanness to create more embodiment and an understanding of your nervous system.
There are no wrong answers and this is not a test. This just allows both of us to get a feel for each other.

Name
First NameLast Name
Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number
Email
example@example.com
Date of Birth
MonthDayYear
Date
Time of Birth
Hour Minutes
AM/PM Option
Location of Birth (City, State, Country)
Please tell me why you would like to go through this process? What are your intensions?
What would be an outstanding, tangible outcome for you that would result from doing this intension?
Why do you want this?
How would you know when you have met your intension, result, or outcome?
What will change in your life (internally and externally) when you have this result or outcome?
What do you know about your own time in utero, birth and postpartum? Were there any significant events such as a death in the family or a move while your mother was pregnant with you? Medical complications such as NICU or medical surgery after birth?
Have you had any previous miscarriages or pregnancies? If so how many and date.
Was this an intentional pregnancy? Did you need any support to get pregnant such as medication or IVF?
In your eyes, what is hindering your process in becoming a Mother (think physical, mental, emotional, energetic, and/or spiritial)?
In your ideal world, what would the next 4-6 months look like in our work together.
Do you feel anything is missing in your life?
What energizes you? What are you excellent at?
What drains you?
What themes do you notice around the struggles in your life?
What personal strengths or qualities or tools do you draw on?
Under stress, what not so great habitual behaviors do you draw on?
What tools, practices, people, teachers, or places do you draw upon that are soothing, grounding, or helpful under stress or difficult times?
What relationships or aspects of relationships are you currently satisfied with and why?
What relationships or aspects of relationships are you NOT currently satisfied with and why?
How would you describe your relationship to knowing your needs, expressing your needs and receiving your needs (from yourself and others)? Where do you excel and where do youstruggle?
How would you describe your relationship to your spirituality, ancestors and connection to lineage (forward or backward)? Where do you excel and where do you struggle?
Do you have any mental health issues (past trauma or abuse, dissociative conditions, psychosis, substance abuse, suicidal thoughts/ ideation/ attempts, addictions, etc.)
Please list any medical treatment you are currently under including prescriptions:
Are you using any plant medicine (past or present)? Are you working with a coach or shaman for your use and process?
Anything I should know about your style as a client... things that work best / work least?
Are there parts of your story you'd like to share with me in writing before we begin? If so, you are welcome to. Everything's allowed here.
Any questions for me?

CLIENT AGREEMENTS
Please read the following carefully. Your signing and returning of this form acknowledge your understanding and acceptance of the terms of service.
I understand that pre and perinatal somatics and craniosacral therapy is a transformational process and, as such, it is very likely that I will experience various emotions and sensations as a result.
I understand that my Practitioner will facilitate and provide support along the way but that, ultimately, I am responsible for my physical, mental and emotional well-being, and I will seek additional appropriate support if necessary.
I understand that somatics affects people differently and that the results of each session may take some time to become fully apparent to me.
I take full responsibility for the level of effectiveness of this program. I acknowledge that is is my responsability to take appropriate action to integrate my sessions. My practitioner will support me with suggestions for aiding the integration process, however, whether I pursue these actions or not is entirely my own decision and responsibility.

I agree to disclose to my practitioner any current usage of prescription medication (including anti- depressants), and/or recreational drugs, as these may affect my results.

I understand that the sessions take place in a non-judgemental ‘safe space’ and that the content of our conversations and any work will be kept completely confidential unless a consent form is signed by the client.

I agree to be responsible for booking and keeping my appointments and for giving notice should I need to reschedule an appointment. I WILL GIVE MY PRACTITIONER AT LEAST 48 HOURS NOTICE if I need to change or miss my appointment. If appropriate notice is not given I undersand that is considered a session or that a late fee of $75 will be paid.

I commit to paying for the program in full prior to our first session, or to paying it off by the end of the program if paying by payment plan (to be negotiated in writing).

I agree to keep my practitioner notified of any medical information that would affect our work together, especially as it pertains to pregnancy.
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