Client Intake — HEALWITHTOUCH

Before your session, please take a few minutes to tell me about what you are experiencing, what has been happening in your life, and what you would like support with. There are no right or wrong answers. Please share whatever you feel is relevant.

Full Name*

Email*

What is going on right now?*

Tell me in your own words what brings you to HealWithTouch and what you would like me to understand about your situation.

When did this begin?*

When did you first notice the symptoms, concern, or change? Did anything significant happen around that time?

Where are you experiencing it?

Describe the location and anything you notice physically.

Pain or discomfort

If you have pain or discomfort, describe where it is, what it feels like, and your current pain level from 0–10.

Energy

How is your energy right now? Describe your typical energy level, fatigue, or anything else you notice.

Sleep

How are you sleeping? Tell me about sleep quality, difficulty falling asleep, waking during the night, or anything else you notice.

Movement / Range of Motion

If movement is affected, describe what movements are difficult, restricted, painful, or different from normal.

Quality of Life

How is this affecting your daily life, work, relationships, activities, or ability to do the things you want to do?

What have you already tried?

Tell me about any medical care, treatments, therapies, supplements, or other approaches you have tried and what your experience was.

Your Goals*

What would you like to change, improve, understand, or experience through your work with HealWithTouch? What would meaningful progress look like to you?

Is there anything else you think I should know before our session?

Is there anything you would prefer not to discuss or anything you want me to be particularly mindful of during our session?

HealWithTouch — Client Intake