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Client Intake Form

At Aligned Birth, we want to get a clear sense of what’s going on for you right now so we can make the most of your Head Trash Clearance session. The questions ahead are here to save time during your appointment, giving us more space to dive into the actual clearing work. Share as much detail as feels right for you. You don’t need to go into the full story or explain where certain fears, beliefs, or emotional blocks came from — what’s most helpful is understanding how they’re affecting you in the present. Your openness helps us support you in shifting what no longer serves you.


There are no right or wrong answers here. You’re welcome to write as much or as little as you feel comfortable with. Everything you share helps me understand what you’re experiencing so we can make the most of our time together.

About You

Beliefs and Spirituality (optional)

Do you have a faith background?
Yes
No
Are you open to insight from any of the following?
The Bible
The Torah
The Quran
Other

What Brings You Here ?

Fears & Stress

What You Want

You don’t need to have everything figured out. Start wherever you are.

Your Inner Voice

What does your inner voice say to you?

Thank you for sharing so openly.


I’m honoured to support you in letting go of what no longer belongs in your life. ✨

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