Intake Form — The Healing Garden

Welcome to Your First Step Towards Healing and Growth

At The Healing Garden, we are committed to guiding you on your journey to emotional and spiritual wellness. Please fill out the intake form below to help us understand your needs and tailor our approach to your unique journey.

01. Complete the intake form for tailored coaching that meets your unique emotional and spiritual needs.

02. Your information remains confidential and secure, ensuring a safe foundation for your therapeutic journey.

Name

First Name

Last Name

Date of Birth

Marital Status

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Why did you choose to reach out to me specifically?

What are your short term goals? Where do you see yourself in 3 years?

What are your long term goals? Where do you see yourself in 5 years?

What are the biggest road blocks when it comes to reaching your goals?

Where do you see yourself when our time together ends? What will make this experience a success for you?

Is there anything else you would like me to know?

Welcome to Your First Step Towards Healing and Growth

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