CLIENT INTAKE FORM

lillylowrey@gmail.com
0401 081 716

Frankston, VIC, 3199

I am deeply honored to walk alongside you on this sacred path of integration and healing, wherever you might be in your postpartum journey.

To create a ceremony that truly honors your unique experience, I invite you to share a bit about yourself and your story through this intake form. Your reflections will help me understand how I can best support you and tailor our time together to meet your specific needs and intentions.

Please complete this form at least 48 hours before our scheduled session, allowing me time to thoughtfully prepare for our work together. Your responses will be held with the utmost care and confidentiality.

This ceremony is about honoring your journey — the challenges, the transformations, and the profound wisdom you've gained through becoming a parent. I look forward to creating this meaningful space with you.

Your name

First Name

Last Name

Your preferred pronouns:

Do you identify as Aboriginal or Torres Strait Islander?

Aboriginal

Torres Strait Islander

Neither

Your email

Your phone number

(###)

###

####

Address

If we are holding the ceremony at your home or other chosen space, plesse provide the address below.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Journey

In your own words, why are you seeking a closing ceremony at this time?

e.g. Processing a birthing experience, marking transition to parenthood, acknowledging physical/emotional journey, honoring a pregnancy loss.

Ceremony Elements

To make the ceremony your own, I encourage you to set up a small altar in the ceremony space before we meet. Instructions are provided in the Closing Ceremony Preparation Handout.

Are there any cultural or spiritual practices you'd like to incorporate?

Is there a poem, reading, or piece of writing you'd like included?

This ceremony includes herb-infused oils, aromatic steam, and various plant materials. Do you have any allergies or sensitivities to herbs, essential oils, flowers, or plant materials that I should be aware of?

Please list all allergies and your typical reaction to them.

Do you have any dietary restrictions, preferences, or requirements I should know about (e.g., vegetarian, vegan, gluten-free, dairy-free, kosher, halal, etc.)? Please specify any food allergies or intolerances as well.

Is there anything else you would like to share or request for your ceremony?

Green Bottle Sliding Scale

Green Bottle Sliding Scale To make this ceremony accessible while honoring the value of this work, I offer the Green Bottle Sliding Scale pricing of $300-$375. This flexible approach allows you to select the fee that aligns with your current financial circumstances. Those who can contribute at the higher end enable me to offer services to others who may need to select the lower end of the scale. There is no difference in the quality or depth of ceremony you'll receive regardless of where you fall on this scale. I trust you to choose the amount that feels both sustainable for you and respectful of this offering. Please indicate your chosen fee below.