First Name

Last Name

Your Email Address

Why did you sign up for this healing program?

What areas of your life are out of flow, or causing you worry and stress?

What areas of your life are already going well?

What do you consider your challenges to be?

What do you consider your gifts and strengths to be?

What negative emotions would you like to move away from?

How would you like to feel emotionally?

Where in your body do you feel that energy is stuck, stopped or blocked?

Do you have any health issues (past or current)?

If you have any health issues (past or current), does anyone else in your family also struggle with this?

How would you like to feel in your body?

What is your relationship with your Mother like? Have you ever felt that she rejected you, or that you needed to keep her at arms distance?

What is your relationship with your Father like? Have you ever felt that he rejected you, or that you needed to keep him at arms distance?

Do you, or have you, practised parentification?

Are there any patterns in relationships that you are aware of? In your own relationship, in your parents relationship etc

What are the three most important relationships in your life?

Do you have a relationship/partner? If not, do you want one?

What is your relationship with yourself like?

Have you experienced any trauma in your life? E.g. neglect, incest, physical abuse, sexual abuse, emotional abuse etc

Have any of your parents or family members experienced any trauma or abuse?

Do you have any siblings? If so, how are they doing in their life?

Has anyone in your family died tragically or at a young age?

Has there been any significant trauma in your family's history?

What is your daily baseline level of happiness?

How in tune are you with your intuition? Why do you say that?

What do you definitely want to experience in your life?

What are three outcomes you are most excited to get out of this program?

Is there anything else you’d like me to know before we get started?