WOMB CONTINUUM CARE 

Health Intake Form

Congratulations on taking this leap to come into relationship with your body in a whole new way through exploring the world of Womb Continuum Care.

Please allow approximately 15-20 minutes to complete this form and return at least 48 hours prior to our scheduled session. If any questions are irrelevant to you just answer N/A.

 Your health is influenced by many factors. This questionnaire provides valuable information which helps me understand the underlying story of your body and wellbeing. 

Some of the questions here are quite personal, including sensitive health, intimacy, and trauma-related topics, so I encourage you to take the time to find a quiet moment to answer in full intimacy with yourself. 

All information you share will remain confidential and remains for private use by Tanya Pensini for the purpose of offering you safe and appropriate Womb Continuum Care.