Request edit access
Inner Fire Devotion with Agni Chandra
I’m really looking forward to getting to know you and supporting you in creating a life you love. Here are some questions that will help me get to know you better so that we can fully dive right in our session.

The process begins NOW. Here is an opportunity in this very moment to drop into your heart and your belly and fill this from a mindful place of reflection. This form is as much for you as it is for me. Time to get really real and give yourself the gift of this moment to tap into your authenticity, your voice and what you really want. The form should take around 10-15 minutes to fill. Enjoy!
Sign in to Google to save your progress. Learn more
Email *
What is your name?  *
What is you gender?  *
How old are you? *
What is your nationality? *
Do u live in Portugal or are you currently visiting this country? 

*applies only for in person session

What is your telephone number (with prefix to your country)?
 *
Please share emergency contact name,
phone number & relationship

*applies only for session in person
 *
What's going on in your life that brings
you here?
 *
What is your need/ desire/ intention for our session? *
How would you describe your spiritual path? Did you take part in any transformative bodywork, therapy, workshops, ceremonies that you find significant for your personal development up to this point?
 *
Did you work with your sexual energy during 1:1 session before?  *
If your answer is 'yes' could you please briefly describe your session from the past?
Have you been dealing with any significant physical health issues recently that may be important for me to know about? If yes, please specify if you're currently under any treatment.
 *
Are you currently dealing with any mental health issues? If yes, please specify if you're currently under any treatment or if you have been receiving any mood/perception-altering medicaments recently.
 *
Have you experienced violation of your sexual autonomy, sexual traumas in past? If so, in full confidentiality, please write if you feel that/how this event/those events still affect(s) your life?
 *
Is there anything else you think is significant for me to know about you? What advice would you give me to feel supported during our meeting? *
Which session are you interested in? (Please read about the details of each one here https://www.agniway.com/sessions)  *
Please propose a few dates when you are available for us to find the best possible solution. 

*if you book online it would be very supportive if you give me your proposal in WET (Portuguese time)

*3h in person sessions are usually offered at 13:00 or 16:00 during the week and weekends.
 *
Do you commit to come on time, after taking a shower in case of a whole body massage, not being hungry or too full and avoid alcohol the day before?

*applies only for session in person
Clear selection
Do you commit to prepay for your session via PayPal or Revolut to my bank account, after receiving email with confirmation about the date you've chosen, to finally secure your spot? 

*depending on the session i will ask for 50% or 100% of the value to be prepayed

 *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms