Intake Forms

All forms are available in PDF and Word formats. Please use the Word form, and email it me. Only use the PDF format if you’re unable to use Word. I like to have it typed when possible. Thanks.

Adult Intake Form

This form is for the following services:

  • Body-Centered Healing
  • Healing Early Imprints for Adults

Download PDF

Download Word Doc

Pre-Pregnant and Pregnant Client Intake Form

This form requires only one be filled out per person.

Download PDF

Download Word Doc

Family Work – Parent & Child Intake Forms

Each parent should fill in one:

Parent Intake Form PDF

Parent Intake Form Word Doc

Child Intake Form PDF

Child Intake Form Word Doc

Intake Information for Parents PDF

Intake Information for Parents Word Doc

How to be in the Play Session With Your Child

Word Doc

Setting up the Zoom Play Space at Home

Word Doc

"Karen Melton has the capacity and skill to work with deeply ingrained patterning like no one I have ever come across. I spent many years in therapy, but until I met Karen, I didn't have the understanding of the core of my issues and how to unwind them. Karen’s love, clarity, intuition, strength, intelligence and depth have truly impacted and changed my life."


Nicteha Cohen – Sonoma County

"For the first time in my life, my nervous system is set at neutral and I am consciously and fully embodied. Everything is different. EVERYTHING. After a tenuous entry into the world as a newborn, and being raised by people who were deeply wounded, I am becoming who I was always meant to be. Thank you Karen. You are helping me and helping all the women, babies and families I will touch now, and in the future. Forever grateful ..."


Melanie C. – Doula & Midwife Consultant