Coaching-Healing Questionnaire

Please Provide Me with Some information

When you take a few minutes to answer some clarifying questions, you'll also get clearer yourself on your situation, needs, and what some next steps could be for you.
After you complete the questionnaire, you'll be led to my calendar to book a complimentary ½ call so that we can discuss how you'd like to work together.
Leave me a note here if you're having financial constraints at the moment.

* Indicates required field

Name *

First

Last

Email *

City, State, Country *

Time Zone *

Phone Number *

If you are in a country other than the US, do you have access to Zoom or Skype? *

Yes No I prefer to use my phone

Are you familiar with Energy Healing and have you ever worked with any type of spiritual energy healer before? *

Yes No Sort of...

Feel free to tell me more *

What area of your life is causing you the most concern right now? *

For how long have you been experiencing this situation? *

How is this situation or circumstance impacting other areas of your life right now? *

Have you solicited any other outside support in the past? And if so, what worked and what didn't work for you? *

Are you currently taking or have you ever been on the consistent use of prescription pharmaceuticals designed to alter mood or behavior? *

Describe for me what will your life look like after your situation is resolved. What will you be doing, being, having? *

How will this impact other areas of your life? How will your work, relationships, health, wellbeing, prosperity be affected? *

Do you believe change can be a possibility for you? *

Submit My Application

Thank you. I will receive your application shortly after you send it, and will respond within 24 - 48 hours.

Energy Healing Questionnaire

Please Provide Me with Some information