Prepare for your first private session

Complete this intake form before your intro session so your time can feel clear, grounded, and personal.

Intro Session Intake

Tell us about you!

Name

Phone Number

Date of Birth

Emergency Contact (Name, Phone #)

List diagnosis, physical pains, mental/ emotional/relational/spiritual turmoil:

List medication, supplements, herbs:

Sleep Quality

Stress Level

Permission to Charge Card on File

What is your wildest dream? If you had a magic wand, what would you create?

I understand that Ruha Embodied Voice is a spiritual and personal-growth practice and is not a substitute for medical, mental-health, substance-use, or other professional treatment or advice.

Form submission[]