“There is a true purpose of our being on this Earth,

To uncover the light and let it shine brighter and brighter.”

New Client Form

Thank you for your interest, the following questions below are to help me get to know you better and show up for you in the best ways possible. You can be as brief or as in-depth as you’d like.

*if you’re interested in a free consultation phone call, email mariaelizabethx3@icloud.com directly

I will reach out to you once this form is submitted to set a date and time for your appointment!

Name

First Name

Last Name

Phone

(###)

###

####

Would you like to receive notifications/updates on future workshops, promotions, and offerings?

What is your main intention for our upcoming session?

What are you hoping to receive from our upcoming session?

Have you received energy work before? If so, what was your experience like?

Have you engaged in any self work? If so, what kind?

Are you looking for temporary relief or are you looking to embark on a deeper inner journey? (Either are ok, this just helps me determine the approach needed.)

What area of your life would you like to see the most improvement? (i.e: work, family, social, love life, financial, sexual, relationship with God, relationship with Self.)

The following questions will be in regards to your nervous system. If you're not sure how to answer the questions you can leave them blank and we can talk about it together.

Whenever you become triggered, do you tend too get stuck on on or off? Do you tend to Fight, Flight, Freeze, or Fawn?

Do you have any practices that help you regulate your nervous system? (For example, if you get stuck on on maybe you do something to calm down and ground yourself, or if you get stuck on off you do something to get yourself moving.)

Do you have any consistent practices that you engage in?

If there's anything you would like to add or disclose please feel free to below.

Thank you for trusting me to hold space and assist you along your journey, whether this is a one time session or the beginning of many, I am honored to be a part of it.