Ancestral HeartHealing™ Intake Form

Thank you for choosing to come on this powerful Ancestral HeartHealingTM journey with me. Together we are going to uncover and transform hidden wounds from your ancestral lineage, activate gifts from your ancestors, and open your heart and the collective heart to receiving MORE peace, freedom, overflow, and success.

Please be aware filling this out is likely to bring up some emotions and memories for you, it is the start of the healing process. Please also be aware that as you complete this form and direct your attention to your family history your ancestors may already begin to sense and respond to this process of recognition. I am here to support you. Please ensure you listen to your Guardian Ancestor Connection Heart ImprintTM for the week before our therapeutic healing sessions begin. Please also complete the journal prompts and conscious healing activities in the Guardian Ancestor Connection guide/workbook/PDF

** Take your time filling this out and use the "Save and Continue Later" button at the bottm :)

Initials:

From the list below check as many areas that concern you

If you felt inner peace and a sense of peace with your life what would that be like/ feel like for you?

How will you know this package has worked? What will you be doing differently?

If you felt ‘WHOLE’ what would that feel like to you? Describe in detail

How are things in your life, relationships, work, family currently? What is going well? What isn’t going well?

Tell me some background around what things were like for you growing up? (Home and school)

What was your relationship with your parents/caregivers like? What did they teach you about being worthy and lovable, unconditionally? Did you feel there were certain conditions on their love? How did they treat you?

What is your relationship with your parents/ caregivers like now?

What was their relationship with their parents like?

Tell me about the person you felt most loved by in your life (if different from parents)

Tell me some background about your family history? Do you know where your parents were born? Do you know where your grandparents were born?

Did your family experience significant events, such as - war, poverty, wealth, homelessness, colonialism, racism, famine or slavery? What is your cultural history and heritage? Are there are any patterns that you are aware of in your family e.g loss, hereditary illness, abuse, divorce

What gifts, talents and interests have you inherited from your family? Are there any gifts and talents that you would love to receive from your ancestors?

If you knew, felt, and believed that there was always enough, that there was an overflow ofresources available to you what would that look like?

If you were not in ‘survival mode’ and felt true freedom, what would that look like?

If you felt completely safe (in yourself, in your family, in the world) , what would that look like?

Please confirm here that you do NOT have seizures, any form of epilepsy, a pacemaker, heart conditions and are NOT taking anti psychotic drugs. *

Have you had any other type of therapy before? And which type? *

Thank you for taking the time to fill this in, let’s make some magic together.

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