Name
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First Name
Last Name
Email
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Phone Number
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What do you want to improve most in your life right now?
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Finish this one sentence, with emotion based words only: "In five years I want to feel..."
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Describe your connection (if at all) to God/ Goddess, Spirit, Source, The Universe Our Creator; what do you call “it" and how connected do you feel to this energy?
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What do you believe a good healer does?
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Are you ready to take responsibility for your life and for the darker aspects of your psyche?
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YES
NO
NOT SURE
Which one are you on the 1-6 scale re: the above question…
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Have you ever done inner child work with a practitioner?
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Have you ever done shadow work with a practitioner?
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Are you on any pharmaceutical medications (including birth control)? Please list.
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Have you worked with psychedelics in a therapeutic way. If Yes, please list.
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How would you rate your eating habits 1-10, 10 being the absolute healthiest (according to your own metrics).
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How would you rate your fitness habits? Do you move daily? 1-10, 10 being the absolute healthiest (according to your own metrics). Please describe.
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On a scale of 1-10 how much do you think you currently love yourself?
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What service(s) are you interested in?
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I acknowledge that A GUIDED SOUL operates on a referral / application-only basis and will only take on clients where they believe there is a fit. Submitting this application does not guarantee acceptance or commencement of services. Services will only commence once an official quote has been accepted by the client.
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Please advise your budget so we can best tailor a package for your needs.
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$8000
$10,000
$12,000
I'M NOT SURE
Thank you for submitting your application. We appreciate your openness and willingness to embark on this journey with A Guided Soul. We will be in touch shortly to discuss the next steps. In the meantime, we encourage you to explore our resources and connect with our community. Your path to healing and growth is valued here, and we look forward to potentially guiding you further.
