THE WORTH AND RECEIVING ROOT SESSION™Pre-Session Intake Form Authentic Transformation™ by Silvia Gálvez Thank you for completing this form before our session. Your answers help me arrive fully prepared so we can use our time together deeply and intentionally. There are no right or wrong answers, only what is true for you right now. 1. Personal Information Full Name Email Phone City / Country Business or Profession 2. What Brought You Here and What You Are Looking For What was happening in your life, business or internally when you decided to book this session? What is the main intention you have for our time together? What would you most love clarity, healing, support or guidance around? 3. Your Relationship with Receiving3. Your Relationship with ReceivingSelect all that resonates, pleaseI find it easier to give than to receiveI feel uncomfortable receiving money, recognition, support or visibilityI work hard but what I receive does not match what I giveI feel guilty when good things come easilyI feel I need to earn love, success, money or recognition before I can receive itI feel worthy of receiving and want to expand my capacity to receive moreI feel unworthy of receiving at the level I truly desireI feel something blocks me right before the next levelI over-give, overdeliver or overexplainI struggle asking for what I truly want or need 3.1 Is there a pattern around receiving, money, visibility, self-worth or business growth that keeps repeating no matter what you try? Please describe it as specifically as possible and when you first noticed it. 4. Where Does This Pattern Affect You Most?4. Where Does This Pattern Affect You Most?Choose all that applyMoney and financial abundanceBusiness growth and clientsVisibility and recognitionLove and relationshipsSelf-worth and confidenceHealth and self-careLeadership and authorityReceiving support from othersAll of the above 5. What Have You Already Tried?5. What Have You Already Tried?Choose all that applyTherapy or psychologyInner child workAncestral or family constellation workSomatic or nervous system workBusiness coaching or strategyMindset work or affirmationsSpiritual practices such as meditation, prayer or breathworkEnergy healing or ReikiTrauma-informed coachingManifestation or Law of Attraction workBooks, courses or self-studyI have done a lot of work and still feel stuckThis is relatively new for me 6. Business Growth, Visibility and Soul-Aligned Strategy6. Business Growth, Visibility and Soul-Aligned StrategyAs a Business Strategist, I help clients implement aligned and effective strategies that support both business growth and soul expansion. Please select the areas where you desire the most support right now:Clarifying what makes me unique and communicating it confidentlyPricing my services confidently and receiving what my work is worthPositioning myself clearly and standing out in my marketSpeaking about my work with confidence, clarity and authorityBuilding credibility, trust and authority in my industryCreating aligned offers or services that reflect the depth of my workAttracting aligned clients without chasing, over-giving or overexplainingCreating sustainable business growth without burnoutBecoming more comfortable with visibility and being fully seenSelling my services in a way that feels authentic and alignedIdentifying subconscious, inner child or ancestral patterns affecting my business growthStrengthening my connection with my purpose, voice and messageExpanding my capacity to receive more money, success, recognition and opportunitiesIntegrating both strategy and soul alignment into my business 7. Your Receiving Ceiling7. Your Receiving CeilingIs there a number, income level, visibility level or version of success that feels like too much, like a ceiling you keep approaching but cannot move past?YesNoI am not sure If yes, please describe it and share what emotions arise when you think about surpassing that level: 8. Inner Child and Ancestral Patterns What was the relationship with money, receiving and emotional expression like in your home growing up? What did the women in your lineage believe about money, success, visibility or receiving? What did the men in your lineage believe about money, success, visibility or receiving? Did you feel emotionally safe expressing your needs growing up?Did you feel emotionally safe expressing your needs growing up?YesSometimesNoWhat role did you unconsciously take in your family dynamic? For example: helper, achiever, peacemaker, caretaker, invisible one, rescuer, responsible one: What would change in your life and business if this receiving block were finally released? What would become possible for you if this pattern no longer controlled your visibility, receiving or business growth? 11. Continued Support and Expansion11. Continued Support and ExpansionWould you be open to continuing our work together if you feel this session is just the beginning of what is possible for you?YesPossiblyNot sure yet 10. Current Business Stage10. Current Business StageWhich best describes your current season?Starting my businessGrowing my businessPivoting or reinventing myselfEstablished but feeling stuck at a ceilingTransitioning from corporate into soul-led workReturning to my purpose after burnout or life changes 12. Anything Else You Want Me to Know?Please share anything you feel is important for me to know before our session together. 13. Confidentiality and Intellectual Property The intake process, methodologies, questions, frameworks, session content, teachings and materials shared through Authentic Transformation™ and Silvia Gálvez are the result of more than 20 years of experience integrating Inner Child Healing, Ancestral Healing, Business Strategy and Cellular Memory work. Please honor the integrity and confidentiality of this work by not copying, recording, reproducing, forwarding, sharing, teaching, posting online or distributing these materials, session processes or methodologies with others without written permission from Silvia Gálvez and Authentic Transformation™. All materials and sessions are intended solely for your personal healing, growth and business expansion. New FieldNew FieldI understand and agree to respect the confidentiality and intellectual property of this work.Thank you for taking the time to complete this form. I personally read every answer with care and intention and will carry everything you share into our time together. By completing and submitting this form I confirm that the information provided is accurate and that I agree to the confidentiality terms above. Your signature belowSaveClear Fecha en la que se firma el acuerdo Thank you for taking the time to complete this form. I personally read every answer with care and intention and will carry everything you share into our time together. 8 + 12 = Submit
