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Welcome Current Clients!

A note on Transformational Assignemnts

The Transformational Assignment work each month is for your own growth and development. You will get out of our work together whatever you put into it. Please view these transformational packets as an invitation to dive a little bit deeper. Each month’s work is supportive of our work together. It is better to get some of the work done than none of it. That said, please keep your scheduled session appointments regardless of your progress through the packet. The goal of the work is to support ongoing growth, awareness and shift over time. The more time you allow yourself to work with each sessions assignment in the weeks before your session, the richer the experience will be for you.

Scheduling Account & Client Log-In

I strongly suggest you register for a client account thru my booking software so you can bypass any forms you’ve already filled out, sign in to your “Client’s Scheduling Page” to reschedule existing appointments and view all upcoming scheduled appointments.

To register for a Scheduling account, click the “Reschedule / Cancel / Edit Questionnaire” link at the bottom of any appointment email.

This will take you to the appointment confirmation where you will find a “Register for an Account” button at the bottom of the page.

Once you have created a scheduling account, please log-in with the email address I have on file any time you book a session. Be sure to check that the time zone is correct.

Intuitive Healing & Mentorship Clients - Booking Links

Intuitive Healing & Mentorship

In-Person Session

Book In-Person

Intuitive Healing & Mentorship

Remote Session

Book Remote

Support & Accountability Call

Schedule once per month

Book Support Call

Calibration Session

Book in month 2/3 + month 5/6

Book Calibration Session

Transformational Assignment Work

Month One

Find Your Taproot: Establish A Foundation of Self Care & Self Love

Month One

Month Two

Promote Pleasure, Play and Rest: Savor Self-Connection

Month Two

Month Three

Authenticity, Boundaries + Personal Power: Build Continuity Between Your Walk & Your Talk

Month Three

Month Four

Build Your Community: Radical Love & Sense of Connection

Month Four

Month Five

Speak Your Truth: Beauty, Service & Sense of Contribution

Month Five

Month Six

Expand Your Vision: Sva Dharma & Right Livelihood

Month Six

Month Seven

Healing Arts Mentorship: Attunement, Presence, Energy Work & Embodied Love

Resources

Client Forms

Client History Form

Please Note: All client information is held in the strictest confidence is never disclosed or shared without your explicit consent. Your email is added to Artemisia’s client list for occasional newsletters.

Name *

First

Last

Nickname / Preferred Name

Today's Date *

Birthday//

Gender Identification *

Preferred Pronoun *

Cell Phone / Main Phone *

Secondary Phone

Email *

How did you find me? *

Occupation / Current School *

Mailing Address

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Contact

Emergency Contact: *

First

Last

Relationship: *

Emergency Contact Phone: *

Alternate Emergency Contact:

First

Last

Relationship:

Emergency Contact Phone:

All questions are optional. They help me know you as you are today.

Important Background Information

What is the most important thing that I should know about you right now?

Personal Support Network

Briefly outline your personal support system as it looks today (i.e., family, friends, health care providers, groups, etc.)

Meditation & Mindfulness:

Any experience with meditation or mindfulness practices? How is this for you?

Religion, Spirituality & Faith:

How do faith, religion, or spirituality show up in your life (if at all)? How do you refer to this? Is there any particular language you would like me to use or refrain from using?

Prior Personal Work

What kinds of personal work (if any) have you participated in or done?

Physical Activity / Exercise / Movement Practice:

Please describe any movement practice, exercise or physical activity that is present in your life right now. How is this currently working for you?

Concerning Touch:

Do you have any conditions that will affect or be affected by touch or moving your body or is there anything you would like me to know about your experience or needs around touch?

Medication & Drugs:

Are you taking any prescription/non-prescription medication or recreational drugs? If so, for what reason?

Medical Background & History

All questions answered below will help me work more effectively with you.

Please check all that apply to you.

Addiction Recovery
Allergies or sensitivities (including severe food allergies)?
AIDS / HIV
Arthritis / Degenerative disc disease / Osteoporosis
Asthma
Bulging or herniated disc
Chronic Fatigue Syndrome
Contact lenses (if they are on during session)
Depression
Eating disorder
Emphysema / breathing problem
Fibromyalgia
Fatigue
Fused vertebrae
Heart condition
Hernia
High blood pressure
Hepatitis
History of physical, sexual, and/or emotional abuse
Low blood pressure
Neurologic Problems
Pregnancy

This is particularly helpful information for clients I work with in-person as I may engage your body in touch or movement (especially Phoenix Rising Yoga Therapy clients.)

Addiction Recovery

Length of Time in Recovery

Please list allergies or sensitivities below: *

Asthma: Do you need an inhaler? *

High Blood Pressure: Do you take medication? *

Hepatitis Type? *

Pregnancy: How far along? *

Surgeries, Chronic Conditions & Injuries

Please list any history of surgeries, major illness, chronic conditions, accidents, injuries, or anything that might be relevant while working with you.Our work together may touch on all aspects of you as an emotional, psychological and physical being. Knowing what your body has being through can be quite helpful.

1. Approximate Date://

2. Approximate Date://

3. Approximate Date: //

4. Approximate Date: //

5.Approximate Date: //

Approximate Date: (copy) (copy) (copy) (copy) (copy)//

Final thoughts:

Would you like to OPT OUT of the use of any of these tools during your session. (Feel free to elaborate below):

Acutonic Tuning Forks
Crystals
Essential Oils / Aromatherapy
Medicine Drum
Pendulum
Rattle
Sage
Singing Bowl

You always get to be in choice and may change your mind for or against any of these tools at any time.

Tell me more...

What do you hope to receive from our work together? What is going on with you in your life right now that inspired you to use a mind-body alternative healing modality? Is there anything else you’d like me to know?:

Please note:

artemisia shine is not a licensed physician/mental health clinician. The alternative healing services provided by artemisia shine are not licensed by the state of California nor are they a substitute for licensed medical care.

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♥ About artemisia

artemisia shine is a transformational ally for other change-agents, healers, empaths, givers and highly sensitive people. She LOVES helping you listen to and honor the longing and intelligence of your heart as you connect with your innate body-wisdom and power. She thrives on being a warm hug and available hand in the scared, hurt places, a co-conspirator in the mischievousness, an ally for the oppressed parts and a raucous rabble-rouser that encourages you to play more wildly! Her greatest joy is to love you up as you embody your unique magic. She knows that together, we can all get more free.

♥ Find me here

artemisia shine
Wild Heart Healing Arts
PO Box 12026 San Luis Obispo CA 93406 United States
707-234-5411
wildhearthealingarts.com

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©2011-2019 · artemisia shine: Wild Heart Healing Arts All rights reserved.
artemisia shine is not a licensed physician/mental health clinician.
The alternative healing services provided by artemisia shine are not licensed by the state of California nor are they a substitute for licensed medical care.

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