The Phoenix Rebirth Method™
Descent → Release → Rebirth
Your answers help me understand the emotional, energetic, and life experiences women are navigating — so I can create healing spaces, tools, and programs that meet you exactly where you are.
🎁 As a thank you, you’ll receive a FREE Somatic Clarity Session (valued at $297) — a pure emotional + energetic coaching session.
This is NOT a sales call — just support, safety, and clarity.
Limited to the first 7 women who complete the survey.
Let’s begin, beautiful.
👇
✨ SECTION 1 — About You
Short Text:
What is your name? *
Email field:
What is the best email to send your session link to? *
Short Text:
Drop your social media link (Instagram, Facebook, or LinkedIn).
Short Text:
What stage of your personal or spiritual journey do you feel you’re in right now?
(e.g. beginning, deepening, rebirthing, stuck, awakening, unsure)
✨ SECTION 2 — Your Emotional Landscape
Long Text:
When it comes to your emotional world, what feels like the number one struggle or challenge you are facing right now? *
(ex: overwhelm, looping thoughts, fear of feeling, shutdown, anxiety, suppressed grief)
Long Text:
What emotions feel the hardest for you to hold or express?
(ex: sadness, anger, disappointment, shame, fear, grief)
Long Text:
What do you fear might happen if you fully let yourself feel what’s inside?
Multiple Choice:
Which of these emotional experiences do you resonate with most? (Choose 1–2)
• Feeling overwhelmed by emotions
• Feeling “too much” or too sensitive
• Feeling disconnected from yourself
• Feeling stuck in emotional loops
• Feeling emotionally numb or shut down
• Feeling afraid of emotional collapse
• Feeling constantly anxious or mentally overloaded
• Feeling grief or emotional residue from the past
• Other (add “other” option)
✨ SECTION 3 — Your Inner World & Self-Connection
Long Text:
Where do you feel most disconnected from yourself right now?
(Body, intuition, self-trust, emotions, clarity, boundaries, identity)
Long Text:
What part of you feels like she is trying to come through — but can’t quite break through yet?
(The deeper version of you, your intuitive self, your grounded self, your healed self, etc.)
Long Text:
What do you wish you understood about your emotions, your nervous system, or your healing process?
Multiple Choice:
What feels like your biggest internal block right now?
• Emotional overwhelm
• Fear of feeling
• Fear of breaking down
• Unresolved grief
• Constant mind noise
• Not trusting myself
• Feeling lost or disconnected
• Not feeling safe in my body
• Other
✨ SECTION 4 — Support & Healing
Multiple Choice:
What type of support feels most aligned for you right now?
• 1:1 somatic healing
• Emotional release sessions
• Guided inner child healing
• Nervous system grounding work
• A structured healing program
• Group healing
• Self-paced tools + practices
• I’m not sure yet
Long Text:
What would you hope to feel, experience, or become on the other side of your healing journey?
Long Text:
If your emotional world completely transformed in the next 12 months, what would your dream “after” look like?
Long Text:
How much would it be worth to you — emotionally, energetically, spiritually — to finally feel grounded, safe, and connected to yourself?
✨ SECTION 5 — Somatic Clarity Session
Multiple Choice:
Would you like to claim your free Somatic Clarity Session?
• Yes, send me the link
• Not right now
✨ END SCREEN
Title:
Thank you, beautiful. ❤️
Description:
Your answers have been received.
If you requested a session, I’ll send your link soon.
Thank you for helping shape the next evolution of The Phoenix Rebirth Method™ and supporting the awakening of women everywhere.
