Begin with a free Consultation.

Let’s begin with a free 20 minute conversation about how I can best design my services for you. Services can be utilized individually or as an entire packaged program. I also offer 2 hour Discovery Sessions or Intro to the Birth Chart if you want to try just one of my services right away.

Upon completing this Intake Form, you will be redirected to book a time with me. Please note, all information is collected to best serve you for your session. All information is kept private and will not be shared.

Name

First Name

Last Name

Date of Birth

YYYY

Time of Birth

(AM/PM)

Birth City/State

Current Address

Address, City, and State

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Occupation and Place of Employment

Work Phone

(###)

###

####

Work Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Relationship Status

Significant Other

Kids/Pets

Emergency Contact Person

Emergency Contact Phone

(###)

###

####

How did you find me?

Referred By:

What days/times work best for you and our sessions?

Which service Option(s) are you interested in?

IF COACHING

1) In your words, what brings you to Life Coaching. 2) What is your primary focus with Coaching (career, life purpose/fulfillment, relationships, work/life balance, growth, getting unstuck, setting goals etc)? 3) Comments/Questions

IF HYPNOTHERAPY

1) Have you experienced Hypnosis/Hypnotherapy before? 2) If yes, how was your experience? 3) Have you ever been treated for a mental/emotional issue? 4) If so, are you currently receiving treatment? 5) Medications/side effects? 6) Are you epileptic or do you suffer from a seizure disorder? 7) Any physical concerns (injuries, pains, surgeries, migraines, etc.) 8) If known, what are the details of your birth (pre-mature, forceps, c-section, etc.?) 9) What brought you in/what would you like to achieve with Hypnosis?

IF EVOLUTIONARY ASTROLOGY

1) Have you had an astrology reading before? What type? 2) How familiar are you with your own Birth Chart? (Not familiar, somewhat, very) 3) What do you hope to learn or achieve with this Reading?

If Other:

*I understand that the cost(s) quoted to me may either be per hour or per session and that the actual length of session may vary

Yes

Begin with a free Consultation.

Luna Point