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Client Intake Form (One-Time)

Thank you for taking a few moments to share this information. Your answers help Moriah support you and tailor your experience.

First name

Last name

Phone

How you found Moriah

How did you hear about us?

Previous Experience

Have you had a reading with Moriah before?

Yes

If yes, you’re welcome to share anything you’d like Moriah to know about your past experience:

What you're hoping for

What are you hoping for from this experience? (For example: comfort, connection with loved ones, support in your grief, insight, reassurance, etc.)

(Please note: While Moriah will always do her best to create a safe, compassionate space, specific people, messages, or outcomes cannot be guaranteed.)

Emergency Contact / Special Circumstances

Please share the Name and Phone Number of someone we could reach if you were to have a medical emergency during your session.

Any health concerns, accessibility needs, or sensitivities we should be aware of?

Is there anything about your emotional, physical, or situational needs that you would like Moriah to be aware of before your session?

(Only share what you are comfortable sharing.)

Marketing Preferences

I’d like to receive occasional emails from Moriah about grief support, readings, and events. I understand I can unsubscribe at any time.

I agree to receive occasional SMS/text messages from Moriah about appointments, readings, and events. I understand that message and data rates may apply and that I can reply STOP at any time to opt out.

(You’ll receive appointment confirmations, reminders, and important updates related to your sessions by email and/or text. These options pertain to additional, occasional marketing messages only.)