Dear Loving Caregiver,

First of all, thank you. You are showing up in a role that asks more of the heart, spirit, and body than most people will ever know. This form is here to support you—not just as a caregiver, but as a beautiful human being navigating something tender, exhausting, and sacred all at once.

Whether you're feeling strong or barely holding it together (or both in the same breath), this is a space to pause… breathe… and check in with your own needs. It’s not selfish. It’s necessary. You matter. Your well-being matters. Because when you’re supported, everyone benefits—including the one you love and care for.

There’s no judgment here, only love. Please take your time as you answer these questions. They’re simply here to shine a gentle light on where you are—and what kind of care you might need right now.

You are not alone.

1. Full Name

2. Email *

3. Phone *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (XXX) XXX-XXXX for assistance. You can reply STOP to unsubscribe at any time.

4. Who are you caring for? (Relationship, age, diagnosis if applicable)

5. How long have you been in this caregiving role?

6. How long have you been in this caregiving role?

7. Do you feel spiritually or emotionally depleted? If so, in what ways?

8. What kind of support are you seeking? (Emotional support, education, coaching, respite, community)

9. Would you like to schedule a private session or join a caregiver circle?

10. Anything else you want Shelley to know?

A Gentle Closing

You’ve taken a brave step just by filling this out. Please take a moment to honor yourself—for all that you give, for all that you hold, and for your willingness to pause and ask: What about me?

You don’t have to do this alone. If you’d like a safe space to be heard, seen, supported, or simply exhale, I’m here for you.

You’re invited to:

💞 Schedule a private session — a soul-soothing space just for you
🌿 Join a Caregiver Circle — a nurturing community of others walking a similar path
✨ Receive resources or guidance — tailored to support your emotional, spiritual, and practical needs

No matter what you choose, know this:
You are doing holy work. And you are deeply, deeply appreciated.

With all my heart,
Shelley

A Gentle Closing

Thank you for taking this time to reflect, remember, and share.

Your words matter. Your stories matter. You matter.

May this be a beautiful beginning—or continuation—of the legacy you are lovingly leaving behind.

With heart,
💗

✅ Next Steps

Once submitted, this form will help determine the best support options available. Shelley may follow up directly to schedule a free Soulful Strategy Session or recommend a specific service or resource.