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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

Important: You do not need to share any information that might hint at who you hope to hear from. Moriah is not asking for details or fishing for information. This form is only to help with scheduling, safety, and making your session as comfortable as possible.

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

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

Is there anything you want Moriah to know to help you feel comfortable?

For example: if you have hearing or tech needs. Please do not include anything you would rather keep private.

Emergency Contact / Special Circumstances

Please provide the name and phone number of someone we can contact in case of a medical emergency during your session.

If you have any health concerns, accessibility needs, or sensitivities that Moriah should be aware of to support you better, please share them below.

(You may leave any fields blank if you prefer not to share.)

Emergency Contact Name and Phone:

Health concerns, accessibility needs, or sensitivities:

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.)

Manage my booking

Accessibility Statement

Terms & Conditions

Refund Policy

Intake Form