Grief Intake Form

Thank you for being here. This intake is designed to help me understand you as a whole person — not to diagnose, judge, or label. Please share only what feels safe and relevant for you today.

Client Information

Full Name

Address

Phone Number

Email Address

Preferred Name (if different)

Please take your time answering these questions. There are no right or wrong responses—only what feels true for you.

Intake Questions

1. What brings you here right now? (What loss or experience are you moving through?)

2. What has your relationship with grief been like—both in this loss and in your life overall?

3. Where are you emotionally right now? (What feelings feel most present or hardest to carry?)

4. What feels most difficult to express, share, or put into words?

5. What are your beliefs, feelings, or sense-making around death? (Spiritual, religious, philosophical, or uncertain—anything that feels relevant.)

6. How did your family of origin relate to grief and death? (For example: Were emotions openly expressed, minimized, avoided, or held privately?)

7. What does your support system look like right now? (Where do you feel supported, and where might you feel alone?)

8. What feels unfinished, unsaid, or unresolved in your grief—if anything?

Optional

Is there anything else you feel called to share before we begin?

Disclaimer:

Intuitive healing is considered an alternative, complementary approach and does not replace the need for traditional medical care through your physician or licensed professional. You should not stop, add, or change any medication or traditional treatment, without the advice, consent and direction of your physician. You are advised to seek the care of a licensed professional for any physical, mental or emotional concerns.

The choices you make and the actions you take are solely your responsibility. You agree to completely hold harmless and absolutely indemnify Soul Mechanics LLC, Kate Foley, LMT, MSCC and any persons associated with Soul Mechanics LLC, and Kate Foley, LMT, MSCC from any and all liabilities and expenses.

The Soul Mechanics podcast is for general informational and entertainment purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.