Single HeartH Tending Session intake form

Thank you for booking your HeartH Tend session. To help me hold a safe and supportive container for you, please fill out the intake form before your session. This will take about 5–10 minutes.

Basic Info

Full Name

Phone

Session Type

Intentions & Goals

What brings you to HeartH Tend?

Desired optional focus for the session

Microdosing Guidance Grief Tending Vessel Support (herbal/nutritional support) Integration Support (spiritual/plant medicine)

Practices & Supports

Current practices

Any ongoing therapies or support systems

Health & Safety

Physical health considerations

Mental/emotional health considerations

I understand that HeartH Tend is a supportive container for self-connection, integration, and exploration, but it is not a substitute for medical or mental health care.

I agree to participate responsibly and communicate any needs, limits, or concerns with my facilitator.

I give consent for my facilitator to use guided somatic, breathwork, and intuitively guided practices during the session.

Anything else I should know to meet you well?