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.
You can ALSO find the calendar link on my Instagram profile in bio and on the
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Mobile Phone Number
Date of Birth
Please state all diagnosed and undiagnosed health conditions and concerns.
How long have you had this/these conditions?
What prescribed medications are you taking? If any.
What supplements or non prescription health products/supplements do you take?
What diet best describes yours
Balanced diet of everything
Lots of snacking/cravings
Never sure what to eat
Do you feel as if you are eating anything "bad" for you? If so what is that food.
How much water do you drink daily?
State one main issue in your life presently you are not happy about and wish to change.
What is the goal you would like achieved as an out come of your treatment?
What is your biggest headache on a day to day basis?
Do you sleep well at night?
What do you believe will happen if you don't get healing at this time?
Why is it important for you to get healing now?
What do you think the root cause of your issue/s is?
What things do you no longer want to experience/deal with?
What do you think is getting in the way of the results you want?
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?
Describe your deepest desire in a single sentence.
Name 3 things, if you had them, would make you feel completely fulfilled.
What is the best way to contact you if you decide to have a session going forward?
Whatsapp - You will need to provide your mobile number above
Facetime - You will need to provide your mobile number above
Zoom - You will be sent an link via email to click and connect to the call
Skype - You will need to provide your Skype name bellow
Skype name if chosen that option above.
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.
I give consent
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