Conjurer Questionnaire

The bond formed through being a Conjurer can be a crucial aspect of women's lives that fosters deep bonds, mutual support, and a sense of community. We strive to provide a safe space for women to share their experiences, struggles, and triumphs, and to receive emotional support and encouragement. By fostering a sense of belonging and empowering each other, we can help each other overcome obstacles, challenge feminine stereotypes, and work towards more equal and fulfilled lives.

First Name

Last Name

Date

Initials

All the information you submit on this intake will be kept confidential. Upon submitting this form, all answers in the boxes will be sent directly to a secure private email, This information will not be shared. You can reserve the right to not disclose your personal history. It is solely up to you which questions you choose to answer. However, all fields are required to have an answer. If you choose to not answer please type, "No Answer" in the field.

3. Which of the following have you experienced in your relationship? Select all that apply.

Physical abuse (hitting, blocking, pushing, property destruction, threats, pinching, pulling hair, keeping you from food, sleep, or medical treatment, etc.)

Sexual abuse (manipulating you to perform sexually when you don't want to)

Emotional abuse (lying, withholding information, criticizing and blaming you when anything goes wrong, denying, justifying, or excusing his own bad behavior, silent treatment, controlling your time or outside relationships, etc.

Financial abuse (controlling money, keeping knowledge of your financial situation from you, driving you into debt, etc.)

Spiritual abuse (using, spirit, karma, creator/god/or any holy text to control what you think or do)

None of the above

4. What kind of help (specifically related to the sisterhood/female empowerment) have you had in your lifetime? Check all that apply

5. Of the things you've tried so far, what has helped you the most and how did it help you?

6. Of the things you've tried so far, what has been the least helpful, and why do you think it didn't help?

7. Describe your commitment level to yourself at this point in your life? How well do you have your own back? If you struggle with this, how badly do you want to grow in this area?

8. This program isn't for everyone. It's for women that are ready to change things in their lives and impact the lives of others. Is that you? Are you ready to be part of a community of women who are serious about doing the hard work of personal transformation? Are you ready to be challenged by new beliefs that will help you make decisions and develop practical strategies to move forward? Do you want your future self to look back and thank you for conjuring up the new HER?

Yes

I am unsure

9. In this program, we don't focus on managing all the circumstances that are out of our control. We have zero power over that. Instead, we turn our focus to where we DO have personal power, and that ultimately sets us free internally. We'll be doing the hard work of looking at life-long patterns of thinking, feeling, and behaving that have sabotaged our happiness, successes, and fulfillment in life. This can feel emotionally draining at times. Are you ready and willing to make the emotional investment this program will require of you so you can feel a lot better in the long run?

Yes

I am unsure

I confirm that the information given in this form is true

Thanks for submitting! We will be in contact with you very soon!