Navigating the Unknown

Intake Form

Thank you for saying yes to your grief! I receive the honor of walking with you in this journey, holding space for and witnessing your unfolding through grief, with great gratitude and delight.

Below is a form for you to fill out to help me orient to where you are at and what you may be needing.

I invite you to notice what arises as you fill out this form. There is no right or wrong experience or answers. ‘I don’t know’ is completely acceptable. What arises is information about where you and your nervous system are currently at. Please be gentle with yourself in your firm resolve to be with grief.

Reclaiming our innate capacity to be with grief in a way that feeds life is one of the most loving choices we can make for ourselves, others, and the world. Thank you for your courage and open heartedness!

Name

First Name

Last Name

Phone

(###)

###

####

What grief/s are you looking for support for?

What is your ideal outcome in moving through grief?

Do you prefer text or voice memos?

Is there anything else you would like us to know?

Payment and Refund

Payments for monthly packages are required upfront. You can make a payment by cash, venmo, cashapp, or paypal. Navigating the Unknown Grief Consultations is non-refundable. However, should you need to take a break before continuing with your remaining sessions there is a 3 month grace period in which you may pause your sessions and pick them back up within that time. I require 24 hour notice for re-scheduling sessions. If sessions are re-scheduled with under 24 hours notice that session will be forfeit, with the exception of debilitating illness or a life or death emergency. Please choose a method of payment below and complete the remaining agreements.

Yes I agree to pay by cash upfront

Yes I agree to pay by venmo upfront: @Mikyo-Black-6

Yes I agree to pay by cashapp upfront: $mikyoblack

Yes I agree to pay by paypal upfront: subrosasanto@gmail.com

Yes I agree to give at least 24 hours notice should I need to re-schedule a session or my session will be forfeit with the exception of debilitating illness or life and death emergency

Yes I agree that Navigating the Unknown monthly package sessions are non-refundable, with a 3 month grace period should I need to pause my sessions