Questionnaire
TAKE YOUR LIFE BACK! Thank YOU for choosing YOU!

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.

If you would like to check availability and book in a time slot for your first one to one you can do that through my calendar link. If you click below it does open in a new tab so you won't lose your form, or copy and paste to use later.
https://calendly.com/pashceremony
You can ALSO find the calendar link on my Instagram profile in bio and on the pashceremony.com website.

Email address *
Name *
Your answer
Mobile Phone Number
Your answer
Date of Birth
Your answer
Please state all diagnosed and undiagnosed health conditions and concerns.
Your answer
How long have you had this/these conditions?
Your answer
What prescribed medications are you taking? If any.
Your answer
What supplements or non prescription health products/supplements do you take?
Your answer
What diet best describes yours
Do you feel as if you are eating anything "bad" for you? If so what is that food.
Your answer
How much water do you drink daily?
Your answer
State one main issue in your life presently you are not happy about and wish to change.
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
Do you sleep well 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 the best way to contact you if you decide to have a session going forward?
Skype name if chosen that option above.
Your answer
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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