Client application form

Client application form
This application form helps me understand where you are in your healing journey and whether we’re the right fit to work together. I deeply value a personalized approach, and this ensures that I can offer you the best possible support. Please answer honestly and with as much detail as you feel comfortable sharing.
Name

First NameLast Name
Email
Instagram handle (if applicable)
Location & time zone
What are you currently struggling with the most? (Emotional, physical, or energetic challenges)
What is your biggest goal or intention for this healing journey?
On a scale from 1-10 how ready are you to commit to deep healing?

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Are you willing to explore the deeper emotional and energetic layers of healing, even if it feels uncomfortable at times?

YesNo
Are you currently working with any other practitioners? (This helps me understand how to best support you.)
Why do you feel called to work with me specifically?
What type of support are you looking for? (Ongoing healing, one-time guidance, deep transformation, etc.)
Is there anything else you’d like me to know before I review your application?
If your application is approved, are you ready to move forward?

YesNo
Would you like to be added to my waitlist or notified of future openings if we aren’t the right fit right now?

YesNo
Thank you for taking the time to fill out this application! I deeply appreciate your honesty and intention in this process.

I personally review each application to ensure we’re the right fit to continue your healing journey. If your application is approved, you’ll receive an email from me within 48-72 hours with the next steps.

If for any reason we’re not aligned to work together at this time, please know it’s not a reflection of you—just that I want to ensure I can fully support you in the way you deserve. I’ll always provide guidance on the best next steps for your healing journey.

Thank you again, and I look forward to connecting with you soon!

Amy 🤎
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