Back to the threshold
Nested Hearth LLC · Surprise, Arizona
Intake Form

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.

Accessibility & things I should know

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

Healthcare

Are you currently working with any healthcare providers?

Emergency contact
You

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.