Soul Healing

Intake Form

There are no right or wrong answers — only your truth.

Please take your time with each question. Your responses will be held in confidence and used solely to guide your soul healing session.

Each box contains a gentle prompt to guide your thinking — simply click inside and begin typing.

Your Name *

Email Address *

1.Please describe the emotional and physical imbalance you are experiencing.

2.When did you first notice these symptoms?

3.What was happening in your life when this illness or emotional impasse first started?

4.Who was the principal that was at the center of this event or circumstances when the dis-ease started and is still ongoing?

5.When you feel the impact of the imbalance, physical symptoms, emotional burdening, what is the primary thoughts running through your head when they occur?

6.Have you ever tried to address these problems with whoever is associated with these ongoing problems?

7.Do you have an idea of what your purpose is in this incarnation?

8.Do you dream or imagine having a different life or direction?

9.What is that alternative path you have thought about?

10.Do you have any places around the world that you have always been drawn to, or have an affinity for?

11.Are there foods or cuisines that you recognize as your body always connecting to, or being most satisfied when eating?

12.Do you have any sense or memory of any of your past lives?

13.How much do you listen to your inner voice or intuition on a daily basis? Do you argue with yourself for wanting to follow your intuition, which many times contradicts what is perceived as the more logical choice or thinking?

14.What do you hope to gain from a soul healing if you were to receive one?

15.What is your age and general overall health? Do you take any modern prescriptions, and how often?