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Extended Energy Work Coaching Application
This application is used solely to gauge whether you are a good candidate for this program. Non-acceptance does not bar you from re-applying at a later time or receiving services. Each application is carefully reviewed so that the maximum benefit can be attained by the healee.
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* Indicates required question
Name (First & Last)
*
Your answer
Email
*
Your answer
Phone Number
Optional. If you would like to do some of the coaching via phone.
Your answer
Address
*
Where you would like your Wellness Care Package sent.
Your answer
What is your present (and previous) experience with energy work?
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Please describe any experience you have with energy work whether done on your own or with others, including healing energy work.
Your answer
What is your primary wellness concern?
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Your answer
What would you like to get out of working with me over the next 6 weeks?
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Please put into as much detail as you can your expectations for working with me.
Your answer
How serious are you about transforming your wellness?
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Rate your level of commitment to changing your life, 0 being lowest and 10 being highest.
Not Concerned
0
1
2
3
4
5
6
7
8
9
10
Seriously Dedicated
Do you have any comments or concerns about working with me?
*
Your answer
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