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Energy Reading Qualification Form

Thank you for your interest in an energy reading consultation.

This form helps me understand where you are in your journey and whether this work might serve you. There are no right or wrong answers—only honest ones.

I review every submission personally and respond within 3-5 days.

Your Name:

Email Address:

Phone Number (optional)

What is your digestive condition?

How long have you been living with this condition?

What treatments or healing approaches have you tried? Include both Western medical treatments (medications, procedures) and Eastern/alternative approaches (acupuncture, herbs, diet protocols, etc.)

What is your current relationship with your condition? Are you managing symptoms? In remission? In an active flare? Stable but vigilant?

What spiritual or consciousness work have you done? This could include meditation practices, plant medicine, energy work, breathwork, therapy focused on spiritual development, etc. If none, that's fine—just say so.

Why does this framework resonate with you? What about the idea of digestive conditions as expressions of a single entity feeding on fear and lack speaks to you?

What are you actually looking for? Be honest. Are you looking for healing? Relief from symptoms? A different way of understanding your condition? Permission to see things differently? Something else?

What concerns you about this work? What makes you hesitate? What questions do you have? What seems unclear or potentially problematic?

Are you willing to work beyond conventional medical or spiritual explanations into uncharted territory?

Are you willing to work beyond conventional medical or spiritual explanations into uncharted territory?
A
B
C
D

Do you understand that this work offers radical reframing, not guaranteed healing?

Do you understand that this work offers radical reframing, not guaranteed healing?
A
B
C

How did you find this website?

Is there anything else you want me to know?

A note about the process:

If we move forward, the energy reading consultation is $200 for 60 minutes. Payment is required at the time of booking through Acuity.

This reading is not a sales conversation. It's a mutual exploration to see if my approach serves you. The work can take different forms—Body Prayers, continued energy readings, I-Ching guidance, or combinations yet to emerge. There are multiple pathways within the circle I'm creating, and we discover together which one is yours.

After submitting this form, I'll review your responses and reply within 3-5 days. If it feels like a potential fit, I'll send you a booking link. If it doesn't feel aligned, I'll let you know honestly and kindly.