Page 1 of 2

Energy Realignment

Full name

Email

Phone number

Location / Time zone

What drew you to this form of healing?

What are you looking to release, realign, or transform?

How long have you been experiencing this pattern, challenge, or imbalance?

Do you remember what originally initiated it?

What have you already tried to shift or heal this?

Are you currently using any practices, supplements, or therapies to work move through this energy?

On a scale from 1-10, how ready do you feel to fully release and receive a deep energetic transformation?

Have you received or experienced energy healing or meditation before? If yes, what types?

What would an ideal outcome or shift look and feel like for you?

Is there anything you would like to ask or share before the session?