Please answer the following questions to get the most from your call with Stephanie. It will improve the efficiency of your time together. Thank you.

CLIENT INFO:

Full Name

Email *

Phone *

Date and Time of Birth

Address

Street Address

City

State

Country

Postal code

CONSULTATION DETAILS:

How did you hear about Stephanie? Did someone refer you?

Please input

Any specific concerns or goals during our call together?

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What is your primary reason for scheduling today - a physical, emotional, spiritual?

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On a scale of 1-10 (10 highest) how well do you trust or have faith in life?

Do you believe transformation is possible for you?

Yes

No

Not sure

Do you currently feel you are...

Stuck in a cycle

Flowing with life

In a yo-yo of highs and lows

PHYSICAL CONDITIONS HISTORY:

What currently causes you the most stress?

Any diagnosed medical concerns or conditions? (copy)

Current medications or supplements you take regularly:

Any allergies, injuries, or symptoms that affect your daily life:

Are there any previous healing modalities that you've tried without success?

SPIRITUAL BACKGROUND:

Do you consider yourself empathic or energetically sensitive?

Yes

Not really

Sometimes

Do you meditate or have a spiritual practice of some kind? If so, how much time do you spend on it daily/weekly?

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Do you consider yourself newly awakened or spiritually experienced?

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Do you believe in celestial or higher consciousness? If so, why?

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Share what blocks or insecurities you are most looking to shift or transform, along with anything else you feel is imperative to share prior to our call together to save time.

Please input

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.