Before We Begin —

A few quiet things to help me hold the space well for you

There are no right answers here. Check what feels true right now. We'll go deeper in our time together.

What brings you in

Check everything that applies — as many or as few as feel true.

Anything else (in your own words, if you'd like)

Accessibility & things I should know

So I can make sure our space works for your body.

Mobility considerations

Is there anything else we haven't already discussed that I should know before we begin?

Healthcare

Are you currently working with any healthcare providers?

Yes No

Provider name (if you'd like to share)

Phone number (optional)

Emergency contact

Name

Relationship

Phone number

Email (optional)

You

Your name

Date

When you send this, your answers travel straight to me by email — nothing is stored on this page or shared anywhere else.

Email app didn't open?

Copy your responses below and paste them into an email to jenn@nestedhearth.com.

That's everything I need.

Your email should have opened with your answers ready to send — just press send and it comes straight to me. If it didn't open, you can reopen the form and copy your responses instead.

Thank you for trusting me with this. I'll hold it gently.