We repeat what we don't repair.
In order to prepare an effective healing kit for you, we need you to delve a bit deeper into your subconscious, take a few deep breaths and answer these questions for us.
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How do you feel right now? *
How do you want to feel? *
Why do you feel the need to heal? *
How has the pandemic affected you? Positive & negative aspects.
How do you sleep? *
What haunts you the most? What disturbs you? *
What is your biggest fear?
What are you hoping for in the near future? *
What is your current living situation? *
Are you open to alternative &  holistic methods to help with self-care, love & healing? *
Required
Name & Age *
Gender *
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