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Full Name (include middle names) *

Name Known As

DATE OF BIRTH (18+) *

CONSENT TO SOUL HEALING SESSION *

Email address *

MOBILE NUMBER *

CURRENT OCCUPATION

What is your main INTENTION for booking this session?

MEDICAL history/ CONDITIONS *

CURRENT MEDICATION/DRUGS/SUPPLEMENTS (AND WHAT IS IT PRESCRIBED/USED FOR?)

ALL past/present PHYSICAL INJURIES/SURGERIES *

CURRENT AREA(S) OF TENSION/PAIN

RATE YOUR CURRENT LEVEL OF DAILY PHYSICAL PAIN FROM 1-10 (1 BEING NONE, 10 BEING WORST PAIN IMAGINABLE) *

HOW WOULD YOU RATE YOUR LEVEL OF SLEEP *

SLEEP

WHAT IS YOUR NORMAL/MOST REGULAR SLEEP CYCLE? *

DO YOU WAKE IN THE MORNING feeling... *

IS YOUR MONTHLY CYCLE REGULAR

WHAT DOES REGULAR MEAN FOR YOU?

DO YOU GET PMS - describe your symptoms/MEDICATION?

DO YOU HAVE CHILDREN?

Have you experienced a Miscarriage(s)/ difficulties conceiving / ABORTION/ Still Birth or Experienced the Loss of a Child

HOW WOULD YOU RATE YOUR MENTAL/EMOTIONAL WELLBEING ( 1 BEING LOWEST SCORE POSSIBLE) *

LIST ONE OR MORE THING(S) YOU DO FOR SELF CARE ON A REGULAR BASIS *

HOW DO YOU RATE YOUR SELF CARE REGIME *

EXERCISE *

WATER INTAKE *

DO YOU HAVE DIETRY ALLERGIES? IN WHAT WAY DOES THIS EFFECT YOU? *

SELECT THE NUTRIONAL DIET THAT BEST DESCRIBES YOUR CURRENT LIFESTYLE *

WESTERN REFLECTS A DIET THAT CONTAINS RED MEATS, PROCESSED MEATS, PROCESSED PRE-PACKAGED FOODS, DAIRY, EGGS, HIGH SUGAR, REFINED GRAINS ETC...

OTHER

CIGARETTES/VAPE? *

ALCOHOL CONSUMPTION *

WOULD YOU CONSIDER YOURSELF TO HAVE HIGH,MEDIUM OR LOW LEVELS OF SELF ESTEEM? *

WOULD YOU CONSIDER YOURSELF TO HAVE HIGH,MEDIUM OR LOW LEVELS OF SELF CONFIDENCE? *

WOULD YOU CONSIDER YOURSELF TO HAVE HIGH,MEDIUM OR LOW LEVELS OF SELF LOVE? *

RATE YOUR QUALITY OF LIFE/ENERGY PRESENTLY FROM 1-10 ( 1 BEING VERY LOW TO 10 BEING AMAZING) *

DO YOU CONSIDER YOURSELF TO BE MOSTLY AN EXTRAVERT OR INTROVERT? *

An extravert’s source and direction of energy expression is mainly in the external world, while an introvert has a source of energy mainly in their own internal world.

DO YOU CONSIDER YOURSELF TO BE MOSTLY SENSING OR INTUITIVE? *

Sensing means that a person mainly believes information she receives directly from the external world. Intuition means that a person believes mainly information she receives from the internal or imaginative world.

DO YOU CONSIDER YOURSELF TO BE MOSTLY THINKING OR FEELING? *

Thinking means that a person makes a decision mainly through logic. Feeling means that, as a rule, she makes a decision based on emotion, i.e. based on what they feel they should do.

DO YOU CONSIDER YOURSELF TO BE MOSTLY JUDGING OR PERCEIVING? *

Judging means that a person organizes all of her life events and, as a rule, sticks to her plans. Perceiving means that she is inclined to improvise and explore alternative options.

DO YOU FEEL FULFILLED IN YOUR CURRENT CAREER/JOB/WORK ( 1 NOT AT ALL - 10 IT'S MY DREAM CAREER) *

WHAT LIGHTS YOU UP? (NATURAL PASSIONS/INTERESTS/HOBBIES?) *

HOW OFTEN DO YOU PRACTICE IN YOUR DAILY LIFE WHAT LIGHTS YOU UP? *

WHAT IS ONE AREA OF MY LIFE THAT CAUSES ONGOING STRESS

GENERAL MESSAGE