Past Life Regression Intake Form
Past Life Regression is a hypnosis technique used to access memories from previous lives in order to help heal current life issues.   
Sign in to Google to save your progress. Learn more
Email *
First & Last Name *
1. Can you enter into a hypnotic state? Have you practiced self hypnosis? Do you have any questions about what hypnosis is? *
2. Have you experienced hypnosis or hypnotherapy sessions? How many? For what purpose? What was the outcome? *
3.  Have you experienced formal Past Life Regression sessions? How many? For what purpose? What was the outcome? *
4.   Have you had spontaneous Past Life recall? Describe. *
5.  Are you a healer? In what modalities?  *
6.   Have you met or do you know your Spirit Guides? Describe. *
7.  What Present Life issue do you want to focus on with PLRT?

What is your compelling need for a session? What issue are you now facing that is causing significant pain and requires a therapeutic resolution?

 *
8.  What are your feelings, thoughts and questions about your issue?  *
9.  How does the issue affect you? Describe a specific moment in the last few weeks to illustrate, including what you saw, heard and felt. *
10.  How long has this been an issue? Has it changed over time? *
11. Who are the Key People involved in your present life issues? Describe your relationship with them in this life, and the current state of relationship. *
12. What information or theory do you already have about the cause and nature of your issue? *
13. What outcomes would you like to get after the sessions? *
14. Do you have a question you would like to have answered? *
15. Are you interested in adding on a Lives Between Lives session for an additional charge? *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms