The Mother Wound And Ancestral Healing Experience Pre-Event Intake Form Authentic Transformation™ by Silvia Gálvez Thank you for registering for this sacred experience. Before we meet I would love to know a little more about you so I can make our time together as meaningful and impactful as possible. This takes less than 3 minutes. 1. Your name and email Full Name Email 2. What brought you to this event? 2. What brought you to this event? (Choose all that apply) A) I want to begin healing or improving my relationship with my mother B) I recognize patterns in myself around receiving that I want to begin understanding and changing C) I want to stop passing these patterns to my daughters or granddaughters D) I sensed my mother's relationship with receiving money or love has affected me in ways I am beginning to see E) I am working on my business and sense something deeper is blocking my growth F) I felt called to it without knowing exactly why and I trust that G) Other H) My mother H) My mother is alive has passed away 3. Which of these feels most true for you right now? 3. Which of these feels most true for you right now? (Choose all that apply) A) I work hard but there is always a ceiling on my income I cannot seem to move past no matter what I try B) I feel unworthy of charging what I am truly worth or asking for what I need C) I sense I am carrying ancestral patterns around money, scarcity or receiving that do not fully belong to me D) I give more than I receive in relationships and find it difficult to change this pattern E) I feel guilty when good things come to me easily or when I receive more than a certain amount F) I sense patterns from my maternal lineage, my mother, her mother or generations before, are quietly running my life and business G) I want to understand what my soul actually came here to create and align my life and business with that 4. The patterns mentioned above can quietly affect many areas of life. Which area of your life feels most impacted right now? 4. The patterns mentioned above can quietly affect many areas of life. Which area of your life feels most impacted right now? (Choose all that apply) A) Money, income and business growth B) Relationships and love C) Health and self-care D) Visibility and being seen E) Worthiness and self-value F) Soul purpose and alignment, knowing what I truly came here to create and express G) All of the above 5. Have you done any previous inner work, therapy or healing work? 5. Have you done any previous inner work, therapy or healing work? (Choose all that apply) A) Yes, therapy or psychology B) Yes, traditional inner child healing C) Yes, traditional ancestral or family constellations work D) Yes, spiritual practices such as meditation, breathwork or prayer E) Yes, soul work or work around soul purpose and sacred identity F) Some but I feel there is still a deeper root I have not reached yet G) Very little, this is relatively new for me H) No, this is my first time exploring this type of work 6. What would you like to experience or begin shifting during our 90 minutes together? 7. Is there something specific about your relationship with your mother, or something you sense your maternal lineage has passed down, that is present for you right now? 8. What do you do professionally? 8.1 Are you currently building or running a business? 8.1 Are you currently building or running a business? Yes, full time Yes, part time or just starting No, but I am considering it No 9. What feels most aligned for you as a next step after this event? 9. What feels most aligned for you as a next step after this event? (Choose all that apply) A) I would love a private session to go deeper into my specific patterns and what is most blocking me B) I am interested in a longer program to work on this more fully over time C) I just want to experience today and see how I feel after D) I am open to whatever feels right after the experience "Thank you so much for taking the time to share this with me. I read every response personally and will carry what you share into our time together. With so much love, Silvia ༺♡༻" Date 6 + 10 = Submit