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Grounded Grace Healing

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Home
Services
- Nutrition
- Grounding
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- Faith
My Story
Testimonials
How It Works

Grounded Grace Healing

Home
Services
- Nutrition
- Grounding
- Evidence
- Relationships
- Faith
My Story
Testimonials
How It Works

×

Home
Services
- Nutrition
- Grounding
- Evidence
- Relationships
- Faith
My Story
Testimonials
How It Works

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Grounded Grace Healing

groundedgracehealing@gmail.com

Personal Consultation Intake Form

Thank you for your interest in a personal consultation. The following questions help me understand your current season of life so that our time together can be thoughtful, focused, and meaningful. Please answer as honestly and completely as you feel comfortable.

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Basic Information

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Date and Time for Appointment Schedule*

Family & Living Situation

Current relationship status (single, married, remarried, widowed, etc.)*

Household members (spouse, significant other, children, stepchildren, or others living in your home)*

Brief description of your current family life and support system*

Spiritual Life

How would you describe your current relationship with God or your spiritual life?*

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Nutrition & Daily Routine

Please describe your typical eating routine.*

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Health Background

Any current medical diagnoses or health conditions you are managing*

Any symptoms or concerns you are currently experiencing*

Any additional health information you feel may be helpful for me to know*

Your Goals for This Consultation

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What are you hoping to gain or work through during our time together?*

How can I best support you?*

Consent & Disclaimer By submitting this form, you acknowledge that consultations provided through Grounded Grace Healing are intended for educational, lifestyle, and faith-based guidance purposes only. These consultations do not replace medical care, diagnosis, or treatment from a licensed healthcare provider. You understand that any discussion related to nutrition, lifestyle habits, stress regulation, or wellness practices is intended to support personal health awareness and informed decision-making. You agree to consult your physician or qualified healthcare professional regarding any medical concerns or before making changes to medications, treatments, or health routines. By proceeding, you confirm that the information provided is accurate to the best of your knowledge and that you voluntarily consent to participate in this consultation.

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Disclaimer: Grounded Grace Healing shares educational content and personal perspectives on wellness, lifestyle practices, and faith informed approaches to health and relationships. Content is intended for educational and informational purposes and encourages all individuals to make informed choices that support individual well-being.

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