Distance Healing | Intake Questionnaire

Questionnaire for a
Private Energetic Transformation Session

Please fill out this application to the best of your ability. I'll review it personally and let you know if we're good to go. At that point we can either schedule a call if you want to connect first or go directly to booking your session. You'll be hearing from me via email.

* Indicates required field

Name *

First

Last

Email *

City, State, Country *

Phone Number *

Time Zone *

Have you ever worked with an energetic healer before? *

Yes No

If so, tell me more *

Tell me the number one area of your life that you are seeking the most assistance with now? *

By not having this issue resolved, how is this impacting other areas of your life? *

Do you have any other pressing issues you'd like to discuss with me? *

What is your spiritual orientation, and if you've had a particular upbringing, please share with me. *

Do you have a regular meditation or prayer practice? *

Are you currently taking any medication designed to alter behavior, mood or consciousness? If so, for how long? *

What vision do you see for yourself once free of this limitation? *

Would you be interested in learning more about private mentoring, group learning or home study opportunities as a way to continue your growth? *

Private, one-on-one Group Coaching I prefer home study alone No, thank you.

I agree to receiving marketing and promotional materials

Submit

Thank you and you can expect a response within 1 - 2 business days.

Questionnaire for a​Private Energetic Transformation Session

Questionnaire for a
Private Energetic Transformation Session