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Sacred Self-Care Registration

Welcome to Sacred Self-Care, where ancient healing wisdom meets modern therapeutic practices. This 90-minute healing journey creates a sacred container for deep renewal and transformation, combining time-honored healing arts with intuitive care for your whole being.

I invite you to fill out this short form so I can learn a bit more about you.

First Name

Last Name

Email

Phone Number

Preferred Contact Method

Preferred Contact Method
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Best Time to Contact

Best Time to Contact
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B
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Which path are you interested in? (please check just one)

Which path are you interested in? (please check just one)
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B

What brings you to Sacred Self-Care today? (please briefly describe)

What areas would you like to focus on? (select all that apply)

What areas would you like to focus on? (select all that apply)
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B
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If "other", please specify.

Do you have any physical conditions or sensitivities I should be aware of?

Do you have any physical conditions or sensitivities I should be aware of?
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B

If yes, please share some of details.

Are you currently pregnant or postpartum?

Are you currently pregnant or postpartum?
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B

Are you currently experiencing any physical or emotional challenges you'd like to share?

Are you currently working with any other wellness practitioners or have you in the past?

Are you currently working with any other wellness practitioners or have you in the past?
A
B

If yes, please specify.

Do you have any questions about the Sacred Self-Care program?

What's the best time of day/week for sessions? (Select all that apply)

What's the best time of day/week for sessions? (Select all that apply)
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D
E

How did you hear about me or my Sacred Self-Care program?

How did you hear about me or my Sacred Self-Care program?
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B
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D

Consent

Consent

Thank you for taking the first step on your journey of transformation. I look forward to exploring the possibilities with you.