Inner Transformation Package Application
Please fill out this short survey to see if you qualify for the Inner Transformation Package.
Name *
Your answer
Email *
Your answer
Phone number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Martial Status *
Occupation *
Your answer
What health challenges are you facing now? *
Your answer
When is the last time you had an energy healing session? *
Your answer
How often do you get a wellness energy healing session? *
Your answer
What is the weakest area of your life right now? *
Specifically, what is your biggest sticking point in life right now? *
Your answer
How long has this been a sticking point for you? *
Your answer
Scale of 1 (no problem) of 10 (massive pain) *
What have you done in the past to solve this problem? *
Your answer
Why wasn't it successful? *
Your answer
What would your life look like if you suffered from this problem for another 3 years? *
Your answer
What would your life look like if you significantly improved this area of your life? *
Your answer
Are you willing to follow simple instructions to improve this area of your life? *
Required
If your application is approved, when is the best time/day to have a 15 minute phone consultation? *
Your answer
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