• Intake Form | Moriah Moksha

    Tell me a bit about yourself so I can customize our session to your needs!
  • Type of Session *

  • Sliding Scale Inquiry

    A limited number of discounted sessions are available per month for those in genuine financial need. If you are unable to meet the standard fee, please briefly share your circumstances below. I prioritize these spots for long-term somatic work and those in acute transition.

  • Astrological Context (optional)

  • To bring further depth to our session, I offer the option to integrate the context of your natal chart into our work together. This is a complimentary addition used solely to customize our somatic and symbolic exploration. If you would like me to reference your planetary placements during our time, please provide your birth details below:

  • Birthday
     - -


  • (Please note that if you cannot provide all three: birthday, birth time and birth location, I cannot access your full astrological chart.)

  • Terms & Conditions

  • Payment

    Invoice and link to payment will be sent by email following session and client is responsible to make payment within 2 hours after session is concluded.

  • Scope of Practice / Legal Disclaimer

    The services provided by Moriah Moksha are for educational, self-reflective, and personal growth purposes only. Sessions are a collaborative, holistic approach designed to facilitate self-awareness and personal sovereignty; it is not a clinical or diagnostic tool. Please no medical question or questions about other people's lives. I am not a licensed therapist, counselor, psychiatrist, or medical professional. Our sessions do not involve the diagnosis or treatment of mental disorders. I review all intake forms carefully to ensure a good fit for our work together. If I determine that my current services are not the right match for your journey at this time, I reserve the right to cancel the session.

  • General Confidentiality

    All information shared during our sessions—including written intake forms, verbal disclosures, and personal reflections—is considered strictly confidential. No information will be released to third parties without your prior written consent, except where required by law.

  • Client Responsibility

    By engaging in these services, you acknowledge that a session with me is not a substitute for professional mental health care, medical advice, or legal/financial counsel. If you are currently experiencing severe psychological distress, trauma, or a mental health crisis, you are encouraged to seek the support of a licensed medical professional. You are responsible for your own well-being and the choices you make based on the insights gained during our time together.

  • Emergency Services

    If you are in immediate danger or experiencing a crisis, please contact your local emergency services or a dedicated crisis hotline.
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