Chrysalis Evolutions — 1:1 Intake Form
Chrysalis Evolutions • Intake Form

1:1 Intake with Aubrey

Your intake is organized into simple sections so you’re never overloaded all at once. Move at your own pace, and share only what feels safe and aligned for this season.

You can pause if you need to and return to complete it later. This form helps Aubrey prepare a personalized, coaching-safe session tailored to you.

Client Basics

Full name, email, mobile/phone, time zone, preferred contact method, and how you heard about Chrysalis Evolutions.

Session Selection

Your preferred service type, format, preferred date & time, and general availability.

Client Context & Goals

Your primary goal, current season or challenge, which Chrysalis Journey breakthroughs feel most relevant, and your familiarity with nervous system work.

You can list names or themes that stand out to you.
5
1 = brand new · 10 = very experienced

Music-Based Exploration

Your relationship with music, a song or playlist that reflects how you feel right now, your playlist link, and how you’d like music to be used in coaching.

Self-Assessment & Readiness

Your readiness for change, energy/emotional state, blocks or obstacles, and the strengths and resources you bring into coaching.

5

Relationship & Support System

Your support network, relationships or dynamics you’d like to explore, and any boundaries or challenges you want to work on.

Safety & Confidentiality

Any safety notes, health concerns, or accessibility needs, plus a simple confidentiality acknowledgment so you can share only what feels safe.

Additional Notes

Anything else you’d like Aubrey to know, specific outcomes you hope to achieve, and any questions or curiosities about the coaching process.

After submitting, you’ll receive next-step details and session booking information.

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