HER Participant Intake Form

Hello Gorgeous,

WELCOME TO THE HER MENTORSHIP PARTICIPANT INTAKE FORM.

I’m so delighted that we’re on this journey together! This form is an opportunity to document and track your transformation by thoroughly capturing where you feel you’re at today. You’ll then be given the chance to fill in the same form at the end of our journey together, and see what’s changed.

If you don’t have time to complete this form now that’s fine – the direct link can be found inside our Facebook group or your welcome email.

It’s entirely up to you how deep you go with this form, give as much or as little detail as you like.

See you soon! xx

Name *

First

Last

Email *

How fully are you currently able to be IN YOUR BODY in your life? *

Almost never. I am usually in my head, thinking about my life and unaware of what's happening in my body.
Intermittently. There are times I am comfortable feeling what's happening in my body, but if I am feeling a challenging emotion or sensation or I'm feeling stressed, I am likely to pop back out into my head again.
Almost always. Regardless of what's going on, I am able to feel myself and stay mostly centred. (Mostly, because we're all human and no one is perfect!)

How fully are you currently able to welcome any MENTAL, EMOTIONAL or PHYSICAL SENSATION that shows up in your world while MAINTAINING PRESENCE? (This includes challenging emotions, thoughts, physical tension etc) *

Almost not at all. I am quite rigid and stuck and definitely resist anything that shows up that I don't feel comfortable with. I am likely to want to distract myself and check out at these times.
Moderately. I have a fair capacity for and ability to make room for whatever shows up and maintain presence with myself, but if I get overloaded/overwhelmed I still lose presence and check out.
Almost completely. I am deeply in touch with what's happening inside me, and am able to be with, welcome and feel anything that comes up.

When you get TRIGGERED by something or someone in your life, how are you most likely to respond? *

REACT! - Freeze/Fawn - On the surface I might look like I'm fine, but I'm actually quite checked out, or even a bit numb in the face of triggers. My mind goes blank and I'm not really sure what to do with myself.
REACT! - Fight - When I get triggered, I have a super short fuze! I will blow up and snap at people, and speak/behave in ways I'm not sure proud of. If I feel a strong need to defend myself or my position, I'm not afraid to get into a confrontation.
RESPOND. (Centred) I stay with myself, even if it feels challenging, I'm able to feel whatever shows up, and respond rather than reacting. I'm comfortable being triggered and dealing with it in whatever way I need to.

How fully are you currently able to experience PLEASURE & PLEASANT SENSATIONS in your body? (Not just sexual, but sensory pleasure as well) *

Very little. My body feels numb, or I carry conditioning around pleasure that has me shut it down.
Somewhat. I have times of feeling immense pleasure and delight in my body, and other times that I am still quite stuck and in my head.
Almost always. I consciously cultivate a state of pleasure in my body throughout all areas of my life!

How awake is your Sexual Life Force or Eros? How alive is it as a creative current in your life? *

Not at all. I carry trigger/shame/wounding around my sex and it's largely dormant.
Somewhat. My sexuality is alive, but I still shut it down in some areas of my life, or have challenges in this area, such as communicating around sexuality or having permission for desires.
My Eros is a powerful force in my life, it is awake, woven into my creations and a part of my conscious day to day experience.

How comfortable are you accessing and moving from your FEMININE/YIN energy in your life? *

Not at all. I judge softer, more feminine energy as weak, unnecessary and frivolous. I have things to do, and that feels like a waste of time!
Somewhat. I understand the value of my feminine, but I still have trouble truly giving myself permission to enjoy that energy in my life. I don't feel super confident in my feminine, yet.
I LOVE my Feminine! I feel more comfortable here than in my Yang energy, in fact, sometimes I think I might even be a bit TOO feminine dominant at times.

How comfortable are you accessing and moving from your MASCULINE/YANG energy in your life? *

Not at all. I judge directional, penetrative energy as harsh and too goal oriented. I am much more focused on being unattached to the way things turn out, Yang energy feels very uncomfortable to me.
Somewhat. I understand the value of my masculine, but still have trouble really allowing myself to bring that energy through and into my world. I am scared of being judged or hurting someone. I don't feel super confident in my masculine, yet.
I LOVE my Masculine! I feel more comfortable here than in Yin energy and think at times I might even be a bit too Yang dominant.

When you notice or uncover a limiting belief, how do you usually respond? *

Avoid/Collapse. I feel so much shame around being imperfect, I honestly just avoid the negative beliefs in my inner world. I don't have any confidence in my ability to truly change them. OR Force/Attack. I deeply want to be able to change my negative thoughts, but I honestly panic a bit when they come up and then try to force them into changing or beat myself up quite a bit.
Get Support/Do the Work/Still a Bit Wobbly. I want to be able to change, and I think that I can. I still find it hard sometimes though and can feel wobbly in my commitment and belief in myself.
Trust/Certainty. I have changed so many limiting beliefs in the past, I trust myself to change this new one I've uncovered. I know that once I uncover a limiting belief, its only a matter of time before I transform it. Time to get to work!

How much certainty do you currently have around your POWER to create a specific RESULT that you want for yourself with ease, trust and precision? *

Little to None. I collapse easily into being under or over active and have a LOT of internal doubt and chatter. Results are inconsistent.
Some. In some areas I'm able to generate the sort of results I want with ease, in others its still challenging and inconsistent, particularly with bigger projects.
Lots! I can manifest and create results on demand in every area of my life without slipping into forcing or collapsing into doubting myself and getting stuff, EVEN with big projects!

What are the main CHALLENGES you're facing right now that you'd love to see change during the HER Mentorship? *

What are the GOALS and VISIONS you're currently working towards that you'd like support with during the HER Mentorship? *

How are you likely to Self Sabotage when working towards these transformations? What are your usual habits, excuses or patterns that come up when working towards something you want? *

Is there anything else you'd love to learn or have support with during the HER Mentorship?

Phone

Hello Gorgeous,

WELCOME TO THE HER MENTORSHIP PARTICIPANT INTAKE FORM.

Talk to me