ShaaniCreates Wellness Consulting Form
Questionnaire for clients regarding ShaaniCreates Wellness Consulting Services. Your information is submitted securely and will not be shared with a third party.
Email address *
Name (First Middle Last) *
Your answer
Date of Birth *
Current Mailing Address *
Your answer
Telephone Number (xxx-xxx-xxxx) *
Your answer
How did you find out about ShaaniCreates? *
Relationship Status *
Are you happy? *
Do you have anger issues? *
Do you love yourself? *
Do you forgive yourself? *
Are you teachable? *
How may we help you today? Please describe the assistance you need regarding your wellness. *
Your answer
Are you available to meet with ShaaniCreates during a video conference? Visit to read about what to use. *
I understand ShaaniCreates consulting services does not replace medical care or treatment *
A copy of your responses will be emailed to the address you provided.
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