GAC Client Form: Customized Healing Plan
Please fill out each question and section below so that we can customize your healing plan to fit your goals and needs.
Email address *
Full Name *
Your answer
Birthdate (Month/Day/Year) *
Your answer
Current home address *
Your answer
Cell Phone # *
Your answer
Are you subscribed to our newsletter? *
If you aren't subscribed, would you like to be? *
How frequent would you like your healing sessions to be with your designated healer? *
Your healing plan will be created for an entire year (12 months). Adjustments can be made if personal issues arise and will be evaluated on a monthly basis by your healer. Your healer may increase or decrease the frequency of your sessions depending upon your progression. Are you 100% committed to a long-term healing plan with your assigned healer? *
Choose a start date for your healing plan. *
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Please choose your preferred availability. *
What services have you received from us in the past? List below. *
Your answer
What service(s) have you enjoyed the most? *
Your answer
What is your Root DNA imprint? If you don’t know, please leave blank. *
Your answer
Do you have your 1-10 DNA Chart? *
Do you have your 1-90 DNA Chart? *
What do you wish to accomplish through working with one of our healers? (Ex. Emotional stability, spiritual growth and evolvement, DNA healing and activation, etc.) *
Your answer
What do you wish to improve within your own life (physically, emotionally, mentally, spiritually, romantically, etc)?
Your answer
What do you consider to be your weaknesses? *
Your answer
What do you consider to be your strengths? *
Your answer
Do you have any health concerns or medical issues? If so, please list them. *
Your answer
Do you suffer from depression, anxiety and/or insomnia? If so, please list which ones and for how long. *
Your answer
Are there certain parts of your body that hurt on a consistent basis? If so, please list them and explain the pain you experience as best you can. *
Your answer
Do you work a stressful job? If so, what are your stress levels like on a scale from 1-10 during the week? *
Your answer
In general, do you consider yourself to be a happy person? *
Is there anything within your life that you’d want to change? (Job, romantic partner, move to a different city/state/country, etc.) *
Your answer
Are there any other health, emotional, mental and/or physical concerns or symptoms that you’d like to address? *
Your answer
Are you potentially interested in our Life Coaching, Astral Coaching or DNA Coaching services? *
Are you potentially interested in attending any of our future workshops? *
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