Shea Rabb

Rootwork

• Presenting concerns: Clients describe their current issues, duration, intensity, symptom timing, affected body areas with sensations, and associated emotional or energetic patterns. 34

• Health, lifestyle, and energetic history: Includes medical history, medications, allergies, prior spiritual or energetic work, self-care routines, substance use, major stressors and supports, and ancestral or family patterns for healing. 56

• Boundaries and safety: Captures physical contact preferences, comfort with smudging and topical herbal applications, scent or herb restrictions, trauma or seizure history, current mental health or medical providers, and accessibility needs. 78

• Intentions and service preferences: Clients state desired outcomes, select preferred approaches such as herbal tinctures or ritual design, specify involvement level, and note spiritual names or traditions to honor or exclude. 910

• Service selection and initials: Clients check services they are interested in, including herbal tinctures, sea moss blends, rootwork, hex removal, space cleansings, aura rebalancing, ritual design, and aftercare, providing initials for consent. 1112

• Practical details: Preferences for session type, best appointment times, financial or scheduling constraints, and referral source are recorded. 1314

• Acknowledgement and consent: Clients acknowledge the complementary nature of services, provide signature and date, consent to contact providers if necessary, and permit appointment reminders. Optional notes for the practitioner are also included. 1516

This document is a comprehensive client intake form template designed for gathering detailed personal, health, and service preference information from clients in holistic or complementary health practices.

• Client personal details: It collects full legal name, preferred name and pronouns, date of birth, phone, email, preferred contact method, and emergency contact information. 12

• Presenting concerns: Clients describe their current issues, duration, intensity, symptom timing, affected body areas with sensations, and associated emotional or energetic patterns. 34

• Health, lifestyle, and energetic history: Includes medical history, medications, allergies, prior spiritual or energetic work, self-care routines, substance use, major stressors and supports, and ancestral or family patterns for healing. 56

• Boundaries and safety: Captures physical contact preferences, comfort with smudging and topical herbal applications, scent or herb restrictions, trauma or seizure history, current mental health or medical providers, and accessibility needs. 78

• Intentions and service preferences: Clients state desired outcomes, select preferred approaches such as herbal tinctures or ritual design, specify involvement level, and note spiritual names or traditions to honor or exclude. 910

• Service selection and initials: Clients check services they are interested in, including herbal tinctures, sea moss blends, rootwork, hex removal, space cleansings, aura rebalancing, ritual design, and aftercare, providing initials for consent. 1112

• Practical details: Preferences for session type, best appointment times, financial or scheduling constraints, and referral source are recorded. 1314

• Acknowledgement and consent: Clients acknowledge the complementary nature of services, provide signature and date, consent to contact providers if necessary, and permit appointment reminders. Optional notes for the practitioner are also included. 1516

U OF LIFE

17 years practicing