Name
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First Name
Last Name
Email Address
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Do You Have A Regular Routine Of Physical Fitness?
Do You Have Any Physical Conditions You Would Like To Heal?
If so...please explain.
Do You Currently Smoke Marijuana?
If so...how often do you smoke or consume marijuana based products.
Do you currently struggle with a drug or alcohol addiction?
Or have you at some time in your life?
If so...Please Explain...
Have You Done Any Street/Party Drugs At Some Point In Your Lifetime?
If so...In What Quantity, Frequency, & Over How Many Months Or Years?
Have You Ever Experimented With Any Psychedelic Drugs Or Psychedelic Plant Medicines
If so...which psychedelics, approximately how many times, & what was your general experience like?
Are you a chronic or social smoker of tobacco?
If So...For How Long? Why Do You Feel You Smoke? Do You Deem This To Be A Problem In Your Life?
Have You Ever Experienced A Major Life Trauma?
(tragic death of a close relation, near death experience, life threatening illness, serious addiction, physical/emotional/sexual abuse, military service in wartime, imprisonment, childhood abandonment, etc...)
IF So...Please Explain Here.
Do You Have A Tendency Towards Depression?
Have You Ever In Your Life Had Suicidal Tendencies?
Do You Often Find Yourself Experiencing Extreme Anger Or Frustration?
If So...When Was The Last Time You Experienced A Violent Outburst?
Have You Ever Experienced What One Might Call A Psychotic Break?
If So...When, What Were The Circumstances, & Do You Feel That You Have Successfully Recovered From The Experience?
How Do You Think Others In Your Life Would Describe Your General Mental State?
How Would You Describe Your General Mental State, Based On Your Thought & Behavioral Patterns?
Have You Ever Been Diagnosed With A Mental Imbalance Or Disorder?
or do you feel you may have some kind of undiagnosed mental issues, that cause disruption in your life?
If So...Please Explain Here...Any Medical Diagnosis, Self Diagnosis, Past Or Current Treatments, & The General Effect On Your Life.
Would You Say That You Feel Especially Comfortable In Your Skin?
If You Were To Describe Yourself The Way You Would Like The World To Receive You, How Would You Describe Yourself In One Sentence?
If You Were To Describe The Way You Most Often Feel Internally, How Would You Describe It In As Few Words As Possible?
Do You Feel Emotionally Strong?
If Not, How Would You Describe Your General Emotional State?
If You Tune Into Your Heart, How Does It Feel?
Are You Currently Married, Single, Divorced?
If Married Or In A Relationship, Do You Feel Your Partner Is Your Soul Mate, Or A Karmic Relationship?
Do You Feel You Have A Close Circle Of Friends Whom You Trust?
Do You Feel Understood By Those Close To You?
How Would You Describe The General State Of Health Of Your Closest Relationships(friends, lovers, family)?
How Do You Feel Your Relationships Could Improve To Help Them Be More Fulfilling?
Do You Feel That You Have A Close Connection To Nature?
Do You Have A Current Practice Of Prayer?
Have You Ever Experienced A Spiritual Awakening?
Have You Ever Had An Out Of Body Experience?
If You Feel Comfortable, We Invite You To Describe Your Experience.
Do You Often Remember Your Dreams?
Have You Ever Had A Psychic Experience?
Do You Feel That You Have A Strong Relationship To Your Intuition?
What Are Some Things That You Do To Help Maintain Your Spiritual Health & Connection?
Do You Often Feel You Are Putting On An Act?
Do You Often Feel Like What You Think & What You Say Are In Alignment?
Do You Often Feel Like Your General Actions Express The Gifts You Have To Give?
How Would You Like To Be More Fully Expressed In The World?
What Do You Currently Do For Work?
Are You Currently Happy With Your Line Of Work?
If Money Wasn't An Object, How Do You Feel You Would Spend Your Time?
Do You Feel Like You Know Your Life's Purpose?
If So...How Would You Describe It In One Or Two Sentences?
