Apply for the Shamanic Healing Immersive ProgramTo be considered as a potential client for this program, please take the time to complete the form below.*All information shared here is confidential Name * First Name Last Name Date of Birth * MM DD YYYY Gender * Female Male Gender Fluid Email * Phone * (###) ### #### What are the biggest changes you want to make in your life in the next 3 months? * List 3 changes What are the biggest changes you want to make in your life over the next 3 years? * List 3 changes What do you most want to achieve for yourself in your life/career? * In your opinion, what are the restraining forces keeping you from achieve these? * What would you say have been your 3 greatest accomplishments to date? * What do you expect to achieve in life as a result of hiring me as your Shamanic Healing Guide? * What is the hardest challenge in your life that you have had to overcome? * What major transitions or life changes have you had in the past two years? (Example: Entering or approaching a different age, a new or different relationship, job role, residence, a change in children’s ages/stages, etc.) * Who are or have been your major role models? Why? * Have you worked with a coach before or a similar one-on-one adult relationship (e.g. tennis coach, piano teacher, and therapist)? If so, what worked well for you and what did not work in the relationship(s)? * On a scale of 1 to 10 with 10 high, rate the quality of your life today. * 1 2 3 4 5 6 7 8 9 10 List five things that you’re personally tolerating or putting up with in your life at present. (Examples: information you can’t find, clutter, rude friends, tight shoes, dented car, job dissatisfaction, dead plants, broken equipment, cranky people in your life etc.) * In a typical week, what do you spend a great amount of time doing? * What are your primary stressors? (What stresses you out?) * On a scale of 1 to 10, 10 high, rate the amount of stress in your life right now. * 1 2 3 4 5 6 7 8 9 10 Your Life Story / History: Would you like to share anything else with me? * Please list any changes you would like to make in the following areas: Family * Romantic Partner Relationship * Career / Sharing your Gifts * Money / Financial Situation * Friends / Social Interactions * Spirituality / Meditation * Living Space / Home * Personal Growth / Learning * Health / Self Care Creativity * Play / Leisure time * Thank you for your application. I will review your answers and contact you as soon as possible. Blessings on your day.