New Client Intake Form

New Client Intake Form

Designed for you to get the most out of your experience.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Exact Time of Birth (include AM or PM)
Place of Birth (Township and Country)
What religious or spiritual beliefs do you feel most connected with?

Animism (Indigenous World View)PaganismSufism or MysticismChristianityBuddhismTaoismNon religious SpiritualityAtheismOther
If you have any further comments about your spiritual or reglious orientation, please list here
What draws you to getting an astrology reading at this point in your life?
What are your main objectives and desires for working with Luna?

Understanding my karma and healing old wounds/mental patternsClarity and direction moving through a transitional timeWorking on a specific issue (relationships/career/finance)Spiritual growth and personal developmentOther
What area of your life that has been most problematic or confusing? (relationships, career, finance, family, health, etc). Think: "what do I find myself complaining or worried about the most?" Try to be honest and its okay to be petty!
What situations are you most likely to feel stressed out or triggered by? To be more specific, click other.

A. Feeling ignored, dismissed or rejected (e.g., being talked over, not receiving a response, feeling brushed aside or the idea that you're too much)B. Feeling judged or criticized(e.g., sensing disapproval, fearing blame and accusation, feeling like I'm falling short of my true potential)C. Perceived unfairness or bias(e.g., favoritism, unequal treatment, social or workplace inequities)D. Feeling misunderstood, unseen or inadequate (e.g., others misinterpreting you, feeling invisible or unacknowledged, self comparison with peer success, performance expectations)E. Loss of control, difficulty in setting boundaries, overwhelm (e.g., plans changing, feeling pressured or forced into something, feeling intruded upon, or unable to set limits that support self-regulation)G. Conflict or tension (e.g., disagreements, confrontation, emotional friction, replaying arguments in the mind, feeling strong urgency to resolve matters)Other
How do you normally react or deal with triggering situations?

I notice that I tend to comfort myself with food, substances, sex or seeking out validation from friends. I can indulge in my emotions and can get attached, clingy and become obsessive. People may experience me as needy.I notice that I can become judgemental, arrogant or critical of myself and others. I may hold grudges, be more withdrawn and unable to feel compassion. I may expect people to come to me and at the same time I push them away. People may experience me as intimidating.I notice that I can disconnect from my feelings and can become aloof, vacant or "spaced out". It's as if I mentally check out from the situation because I don't anticipate there being a positive outcome. People may experience me as distant or not available.Other
What habits, structures, resources, circumstances or people do you consider most beneficial to your well being right now?
What personal qualities or strengths do you wish to cultivate further? What sort of person do you aspire to become?
What are your goals or hopes for 2026?
Clearly state your core intention for your session in one sentence.
Are you open to receiving a monthly newsletter, written to inspire connection, personal growth and healing? (you can cancel anytime!)

Sure, sounds good!I'll pass, thanks
How did you hear about Luna Feyth?
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