Name *

First Name

Last Name

Date of birth *

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YYYY

Which session are you booking in for? *

Soul Embodiment

Breathwork Journey

Reiki

Have you or do you experience any of the following? (please tick below) *

Asthma

Diabetes

High blood pressure

Low blood pressure

None

Are you comfortable with crystals? *

Yes

No

Have you experienced healings before? Please tick all that apply: *

Massage

Acupuncture

Kinesiology

Reiki

Sound Healing

Breathwork

Other

None