Metaphysical Counseling / Coaching / Mentoring Intake and Application
*Please complete this form in its entirety for full consideration.
** Allow 2-3 days for a follow-up. You can send an email to
to confirm receipt.
***Application acceptance are based on several factors including fit, readiness of student and availability. Please note not all applications are accepted.
****Services offered have not been evaluated by the US Food and Drug Administration and is not intended to diagnose, treat, cure or prevent any disease. Those seeking treatment for a specific dis-ease should consult a physician/holistic physician prior to using our service.
THIS FORM CANNOT BE SAVED, PLEASE ALLOW 20 MINUTES TO COMPLETE THIS FORM.
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No, I do not want to be added
Confidentiality Statement: Do we have your permission to contact you, discuss with you or leave messages for you via the method of contacts you have provided. The issue of confidentiality and trust between us is paramount. Do you also understand that our conversations will not be discussed outside of our sessions. There are times when references from other professionals may be helpful; however your name or any suggestion that may lead someone to infer the discussion was about a particular client will not be used.
I have read and I understand the statement above
What is the one (1) issue that you want to focus on at this time?
If you have more than 1 thing, list the most important to you right now. You will get a chance to list other concerns below..
Why now? Why are you seeking to address this challenge or goal now?
What would a positive resolution(s) or outcome(s) look like?
On a scale of 1 - 5, how much effort are you willing to put in to overcome your challenge?
(1 is little or no effort, 5 is all out effort what ever it takes)
1 (little or no effort). I don't have a lot of time. This is not a priority.
2 (willing to give this a try, but this is not my highest priority)
3 (willing to do what I can some of the time)
4 (willing to devote considerable time or effort)
5 (willing to do whatever it takes, even if it means giving up something else I attach more value to)
What options or efforts have you tried to resolve the challenge?
Or what steps have you taken towards this goal?
What do you feel when you think about this?
(Please use as many emotions or descriptive feelings as you can to describe how you feel)
What have you NOT tried yet, but would be willing take action towards if you had the support?
What do you feel or think is holding you back from overcoming this challenge or reaching this goal?
Use personal examples. Try to avoid other people or external factors for now.
How would you feel once this issue is behind you?
What other concerns do you have that you sense may effect your outcome(s)?
List any other challenges you are facing at this time. Any concerns.
What spiritual or religious system(s) do you practice or feel most connected to?
(As a UniverSOUL mystical coach, I align coaching examples with your current system to help support your spiritual bridge of connections. Please list as many as you need to.)
African Diasporic (Vodun, Santeria, Lukumi)
East Asian Systems (Taoism, etc.)
Mysticism, occult, Christian mysticism and esotericism
Of the three areas listed which is most important for you to focus on now?
Please choose only one (1). These work together as a unit; however your focus determines where we start and how we evaluate your "success"
Self Possession (knowing who and what you are, standing in your own truth, and operating from centered and rooted place)
Ancestral and Spiritual Reconnection (Becoming closer to the inner / deeper aspects of self)
Courageous Self Love (Developing and practicing courage, self love, and acceptance)
Metamorphososis: Understanding Your Power as a Woman. Understanding your power as a being.
Non-specific: General Self development
Which areas do you feel the most challenge?
Please pick only three (3) choices that you sense is holding you back from highest living
Believe in myself more
Get unstuck (slow to move)
Being full of joy or ability to experience joy
Live my life purpose / feel divinely guided
Expand my spiritual awareness
Expand my spiritual knowledge
Tap into higher wisdom
Prepare for / Weather a an upcoming "storm" or valley
Create my own self empowerment ritual or practice
Increase vital force energy
Connect with my ancestors
Tap into spiritual support better
Feel better / take better care of myself
Accept more love/ create more loving relationships
Have more fun / not be so "serious" all the time
Be more creative in all I do. Let "me" shine
Express my true self unapologetically
Having the courage to be me
Doing the things I love
Harmony in my life (finances, love, ecetera)
Atonement (lovinging healing shame and guilt)
How my spiritual coaching/mentoring works?
After our consultation, we help you create your HIGHER SELF intention statement for our initial work together. This statement will guide our journey but will be adjusted as needed. A counselor, mentor or coach helps you get clear about hidden desires, potential, or obstacles, but the real teacher is inside of you (your Higher Self). This is not always comfortable. As a matter of fact, healing takes courage, is generally uncomfortable and sometimes even painful memories rise up. We also assist in finding spiritual, emotional, physical tools to support you. You may be guided to watch a video, listen to an audio, complete a questionnaire, practice an exercise(s), just journal or do nothing. You may be guided to seek other professional help. It will depend on your unique journey. Each session is unique, but typically there's conversation, knowledge shared, discussion of life issues, consultations with inner healer, affirmative prayers and more. You are not bound and may stop at any time for any reasons. Please be sure to read and understand your financial obligations. *** In some cases, you may be advised to seek help with a mental health professional, physicians or other sources. Lastly, under no circumstances will we guide or advise you to cease medication or other therapy. Instead, we encourage you to speak to your physician and other conventional medicine support to ENSURE working with us is complimentary.
I have read the above statement and understand it.
Initial Payment Expectations
First consultation is 80 minutes and is paid at the going rate (see
) prior to the session. Payment for subsequent sessions must be paid prior to the session. A payment form is provided outlining late fees and other details.
I have read the PAYMENT EXPECATIONS statement and understand it.
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