Restored Capacity™

Capacity Restoration Session

Your Intake Questionnaire

This brief questionnaire helps Roshonda understand where you are, what you are carrying, and how to make your session as intentional and effective as possible.

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Let’s begin

Tell us a little about yourself.

Your responses are confidential and shared only with Roshonda to prepare for your session.

Your responses are confidential.
This information is used only to prepare for your Capacity Restoration Session.

Question 01 of 06

How would you honestly describe your current capacity level?

There are no wrong answers. This helps Roshonda meet you exactly where you are.

Running on empty — I have very little left
Depleted but functioning — pushing through on fumes
Inconsistent — some days okay, others completely drained
Maintaining but wanting more — I know something needs to shift

Question 02 of 06

Where is your capacity being drained the most right now?

Select all that apply.

Work and professional responsibilities
Family and caregiving demands
Emotional and relational stress
Health and physical symptoms
Mental overload and cognitive fatigue
All of the above — it is coming from every direction

Question 03 of 06

How is your body responding to where you are right now?

Select all that apply.

Chronic tension or tightness
Fatigue that sleep does not fix
Difficulty being still or slowing down
Disconnection from my body — I am not really in it
Physical symptoms I have been ignoring
My body feels okay — it is more mental and emotional

Question 04 of 06

What do you most hope to walk away with from this session?

This helps Roshonda shape the session around what matters most to you.

Clarity on what is draining me and why
A concrete plan to start restoring my capacity
To feel seen and heard by someone who understands
To understand what sustainable capacity looks like for me
All of the above

Question 05 of 06

On a scale of 1–10, how urgent does restoring your capacity feel right now?

1 = I am exploring  ·  10 = I cannot keep going like this

Exploring Cannot keep going
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Question 06 of 06

Is there anything else you want Roshonda to know before your session?

This is your space. Share as much or as little as you like.

Sending your intake to Roshonda...

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Your intake is received.

Thank you for taking the time to share where you are. Roshonda will review your responses before your session so she can show up fully prepared to meet you exactly where you are.

What happens next

You will receive a confirmation email shortly. If you have not yet scheduled your session, reply to that email or reach out directly to roshonda@restoredcapacity.com to confirm your appointment time.

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