Intake Form - Mentoring — EarthStar.Birthing

Please complete this form prior to your first session, and with enough time so I have your address to post you some rose tincture and / or any other herbs if needed.

All information will be kept safe and confidential. All information will be viewed in a compassionate and non-judgemental capacity.

Please make payment of £70 / £50 for students of the School of Intuitive Herbalism / £180 for a block of 3 sessions, before your first session to:

Account Number: 75471809

Sort Code: 600238

Account Holder: EA Taylor

Reference: intuitiveonline

Once I have received your form I will be in touch to book a date for our first meeting.

Any queries get in touch:

emily@earthstar-birthing.co.uk

Mentoring

Name

First Name

Last Name

Postal Address

Do you have any allergies or any reason to believe you may be allergic to a plant:

Do you have any experiences of mental health challenges either past or present:

Are you pregnant or Breastfeeding:

Do you have a sensitivity to Alcohol (we may use tinctures in the sessions which contain alcohol. Most of the alcohol will evaporate when mixed with boiling water, but do let me know if you need to avoid alcohol completely, and I can accommodate.)

Yes

Please share briefly what your experience with herbalism?

Are you studying with the School of Intuitive Herbalism or another training school?

What support are you looking for with mentoring?

This may be a specific area of study, guidance with cultivating a deeper connection with the plants, or support and clarity

Anything else you would like me to know or any questions?

Please tick if you are happy to be added to my mailing list for other offerings

Yes