Awakening Man — Intake Form

01Who You Are

Full Name

Date of Birth

Time of Birth

Place of Birth

Email

Phone / WhatsApp

Where are you living now?

What do you do?

02Your Body

Height

Weight

Build

Ayurvedic Dosha

How the elements live in your body and temperament.

Vata — Air & EtherLean, light, cold. Creative and quick; scattered when off.

Pitta — Fire & WaterDriven, intense. Sharp when focused; inflamed when off.

Kapha — Earth & WaterSteady, nurturing. Grounded when balanced; heavy when not.

Vata–Pitta mix

Pitta–Kapha mix

All three roughly equal

Not sure

How does your energy move through the day?

How do you fall asleep?

Average hours of sleep per night

Anything your body is asking to be seen?

03Your Daily Life

What does your morning actually look like?

What does your evening look like?

Phone time per day

How do you actually nourish yourself?

04How You Love & Connect

Primary Love Language

Words of AffirmationYou feel loved through words — being told you matter, being seen out loud.

Acts of ServiceSomeone doing something for you, quietly and without being asked.

Receiving GiftsThe fact that someone was thinking of you when you weren't there.

Quality TimePresence. Phone down, conversation real, you feel chosen.

Physical TouchContact. Warmth. The body remembering it belongs somewhere.

Attachment Style

SecureCloseness feels natural. You trust without overthinking it.

Anxious / PreoccupiedYou want closeness and can worry it won't be reciprocated.

Avoidant / DismissiveYou protect your independence. Emotional needs can feel like a lot.

Disorganised / FearfulYou want closeness and fear it at the same time.

Still figuring it out

Erotic Blueprint

EnergeticSpace, breath, anticipation. Aroused before anyone touches you.

SensualAll five senses need to be awake.

SexualDirect, visual, physical. You know what you want.

KinkyPower, taboo, psychological charge. The edge is where it lives.

ShapeshifterAll of the above, depending on the moment.

Not sure yet

Current relationship status

What do you know about yourself in relationship that you wish you could change?

05Patterns & Themes

What theme keeps running through your life?

How do you respond to stress?

Your relationship with money

Your sexuality right now

Your relationship to anger

Your relationship to grief

Your creative life right now

Spiritual practice or inner life

06What You're Carrying

Current supplements / herbal support

Current medications

Nothing shared here leaves this document without your permission.

Relevant health history

Alcohol, cannabis, or other substances

No judgement — this is body and nervous system context.

Any history with addiction or recovery?

07Your Edges

What do you want to start — or do more of?

What do you want to stop — or do less of?

Where do you feel most stuck?

Where do you feel most alive?

What are you ready to stop pretending about?

08What You're Here For

You know you're meant for more. And you're done with anything that isn't going to take you there.

What brought you here?

What do you most want from this?

What are you afraid of?

Have you done work like this before?

What would feel like a real yes at the end of 8 weeks?

Anything else?

Before we begin,tell me about yourself.

Before we begin,
tell me about yourself.