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Intake Form

Intake Form

This intake form is designed to receive relevant information for the Shamanic Journey Healing. Please fill it out in as much detail that you are willing to share to make sure that your Shamanic Practitioner, Nicolle, can facilitate your journey and help you access what  will best serve you in fulfilling your desired intentions. 
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    City, State/Country
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    If someone referred you please write their full name below.
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    Keep in mind Shamanic Journeys may last up to several hours while a Shamanic Shadows Healing or Sacred Ceremonies may be more time comprehensive for the thorough approach to covering a lot of ground within one session which for some can be up to 6 hours. Nicolle will try to accommodate your session, including options for evening availability.
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    Your astrological Birth Chart is like the blueprint to you which is as unique to you as your own fingerprint...since it is determined by the exact moment of your birth, in how the planetary alignments were configured at that moment in time. Which the art and science of astrology is the ability to interpret the themes represented in the Cosmic archetypes in unique arrangements making up your own unique birth chart. There is much you can delineate from looking at a chart...as it does paint a picture of the personality lens that you perceive, receive and create reality through; as well as compatibility, and predictive astrology. It is especially complimentary to your shamanic journey to understand the many layers of yourself through self awareness, in why you are uniquely the way you are....but what can be learned can also help explore healing in your Shamanic Journey based on innate attributes represented in your chart, alongside the intentions you set up to be explored while in journey. If you are interested in upgrading your journey to include an astrological reading, that may also include intuitive insight and manifesting mentoring within your astrological blueprint...that can be further explored in journey...then please fill out the details below. (Keep in mind this is a $75 upgrade although normally $100 as a standalone service).
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    If your answer is yes, please write down the name of the person/s, your relationship to them, how they deceased, and how that has affected you since? Also please mention if given the opportunity to connect to the soul of any of the mentioned passed on loved ones while in journey, would you welcome this?
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    Such as Higher Guides, Angels, Guardians, Passed on Loved Ones, SOURCE/GOD/CREATOR, Ancestors, Elders, Star People, Ascended Masters (ex. Jesus, Buddha, Lao Tzu, etc), Galactic Federation, etc.
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    List any questions you'd like answered in order of importance to you, this may reflect personal questions or questions pertaining to humanity or our planet, or beyond...
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    Depending on your interest in diving deep into healing past traumas, we may take the direction of a Shamanic Shadows Healing journey which is a very comprehensive dive into attempting to heal and integrate original timelines where specific traumas took place for you. Our inner "Shadows" if you will, can be considered the unhealed aspects of self, that may have caused fragmentation or dissociation in ones consciousness....this may be where your pain, anxiety, depression or fear originate from or reside within. So even though we often will try to cope with, by avoiding, numbing, escaping, bypassing, rejecting etc... these aspects within us, which often result in sabotaging ones own happiness or wellbeing in the process of, because these aspects much like a shadow, will follow you until resolved. With honest self-reflection, you may recognize patterns in life or your reality, your relationships, or within yourself that are a byproduct of these "Shadows" or wounded aspects of SELF. If you are interested in diving into your Shadow Work, please detail below any relevant traumas that stand out to you that you are aware of. This may include experienced abuse (if comfortable to share, please reference the age you were when these occured, and the extent of the abuse such as physical, emotional, psychological, sexual or other. Reference how you believe this has impacted you in life or any noticeable patterns that may not be serving you?); other examples may include experiencing death or loss; Injuries; Illness; accidents; bullying; perhaps it may be that you felt unloved, unwanted, neglected or rejected in your upbringing; major life changes such as divorce, abortion, miscarriage, or other unexpected or unwanted changes?? etc.
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    It is important to reflect upon your intentions, as they do help create the "road map" if you will as to what may be awaiting you in your shamanic journey. The more clarity of thought you put into this, will reflect in the profundity of your own unique experienced journey. Intentions may primarily reflect the questions you were seeking answers to in the form of guidance, they may be wanting to address your shadow work; Inner child healing; Past life karmic healing; knowing ones purpose; developing ones own Intuitive abilities; Connecting to your loved ones or Guides; Inter-dimensionally traveling; Cutting cords; Seeking assistance with attachments or malevolent entities; Connecting to your Higher Self or Future Self; feeling ONE with ALL; Feeling Peace or Love; etc. These are some possible examples, but anything is possible within journey based on what you are seeking, your intentions and what you are most receptive or ready for. Try to arrange your intentions in order of your priority.
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    This is a chance to check in with yourself. How in tune do you feel you are with your emotions, your wants and needs? What kind of thoughts, words, or actions do you direct to yourself....meaning are they self-serving, do you self-sacrifice, self-loathe or self-deprecate? Do you consciously or unconsciously withhold from yourself...do you punish yourself...do you ignore your inner voice or emotions? Do you do whatever you can to not feel what your feeling by indulging in coping methods that are destructive to your wellbeing...such as binge drinking or eating; taking drugs or pharmaceuticals; losing yourself in TV or other addictions such as pornography; etc? OR alternatively, you have done much healing and work on your relationship to SELF already, and you feel this is pretty healthy for you? Please reference how you therefore meet your own needs and wants; how you maintain balance and wellbeing; what are your current practices that nurtures YOU?
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    How are you feeling? Deep down? There may be many layers to this...ask yourself what emotions come up for you when you ask this? What emotions or states of being, is persistent or most often experienced that you feel may be holding you back? And see if you can identify why those feelings come up for you? What triggers them? Where do they originate? How long have you been feeling those ways?
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    Type the name of the person, their relationship to you, and what has occurred within that dynamic to cause the current unresolved feelings that may still be afflicting you? List all relationships that apply, especially if it pertains to your intentions for healing.
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    Please detail all that applies:
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    Try to identify and describe what these are for you and how they play a role in limiting you?
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    Please detail if this is your current feelings and whether or not you have attempted this in your life?
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    If so, how long have you been on these medications.
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    Please note what reasons you are taking these medications
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    Please be honest with yourself as you reflect on this and detail what you believe what these are for you:
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    Examples would be Cannabis, CBD, Psilocybin, Ayahuasca, Kambo; Rapé tobacco snuff; Peyote; San Pedro Bufo etc. Please detail what you have experience with if so, and if you feel you have benefited from working with any of these medicinals?
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