Apply to work with Clare J
TAKE YOUR LIFE BACK! Thank YOU for choosing YOU!

This is the start to your realisations and realising your dreams. Even if you just do this form and don't take it any further you should see some positive shifts in your life.

Please fill in as many of these questions possible, if you'd prefer to leave any blank that is fine as well.
This is your process but I advise you to give as much information as possible for the biggest obtainable energy shift and profound healing.

Email address *
Name *
Your answer
Mobile Phone Number
Your answer
Date of Birth
Your answer
Occupation
Your answer
Interests
Your answer
What do you feel is holding you back in life?
Your answer
What was the last obstacle in your life you have overcome?
Your answer
What are you struggling with the most externally?
What is your biggest internal struggle right now?
Your answer
What do you want most in life?
Your answer
State one main issue in your life presently you'd consider the top priority for healing.
Your answer
What is the goal you would like achieved as an out come of your treatment?
Your answer
What is your biggest headache on a day to day basis?
Your answer
What keeps you up at night?
Your answer
What do you believe will happen if you don't get healing at this time?
Your answer
Why is it important for you to get healing now?
Your answer
What do you think the root cause of your issue/s is?
Your answer
What things do you no longer want to experience/deal with?
Your answer
What do you think is getting in the way of the results you want?
Your answer
Have you had other experiences with healing?
If you could wave a magic wand what would your life look like in 6 months to a year?
Your answer
Describe your deepest desire in a single sentence.
Your answer
Name 3 things, if you had them, would make you feel completely fulfilled.
Your answer
What is your preferred method to use, if we both decide to work together moving forward?
Privacy Policy and GDPR *
Please tick to give your consent to the storing and using of your personal information, for the purpose of your on going healing and so that we may get back in touch with you. All information is confidential and never shared with 3rd parties. Thank you.
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