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✨General Rootwork Client Intake Form✨

Birthday
Month
Day
Year

✨ Situation Overview

(What’s going on? How long has this been happening? Who is involved?)

3. Is the situation:
New
Ongoing
Repeating pattern
Sudden change
Not sure
4. Which area(s) of life does this concern?

(Names, DOBs if known, relationships to you)

6. Have you worked with any other practitioners on this situation? If yes, what was done?
No
Yes

If yes, what was done?

Desired Outcome

(Be specific.)

8. How urgent is this for you?
Low
Moderate
High
Extremely urgent
9. Are you open to an outcome that may look different from what you imagine if it aligns with your highest good?
Yes
No
Unsure

Practical Context

Court dates, rent deadlines, conversations, job interviews, etc.)

Spirtual & Energetic Background

12. Have you done any spellwork, rituals, or spiritual practices related to this issue?
No
If yes, explain:
13. Has another practitioner ever done work for you on this situation?
No
If yes, explain:
14. Do you feel this situation involves:

Client Participation Agreement

16. Are you willing to participate in any required actions (cleansing, journaling, offerings, communication, etc.)?
Yes
No
Possibly
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17. Are you currently working with any other spiritual practitioner?
Yes
No

(Only share what you're comfortable with.)

Additional Notes

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