Terms
Guarantee


LAW OF ATTRACTION RELATIONSHIP COACHING FOR SINGLES

Note: You can have your private Relationship Coaching session with Sage before or after you clear your background checks (for participation in SoulMates Matchmaking), or you can just do coaching sessions separately.

 CLIENT INTAKE FORM -
Law Of Attraction Relationship Coaching - Singles

This intake form will help you self-assess and focus your session, to maximize your healing.

All information herein is completely confidential and used only for the purpose of facilitating your personalized healing. Please answer all questions that are relevant for you. Thank you!
* Required Fields
* Name:

Birthdate:

Spiritual Name or Nickname:

* Phone: -

* Email Address:

* Sex: M F

* Marital Status:

* In what areas of your life do you most want to create positive change?
Please click on all that apply.

finding my soulmate sacred partnership health

right livelihood/wealth

spiritual awakening enhancing creativity balance

self-love and esteem letting go/healing grief

weight and eating stress reduction

conscious parenting increasing joy

spiritual development/intuition

other:


* If you could set 3 goals for what you most want to accomplish with your session(s), what would they be? Consider all aspects of you life: physical, sexual/social, financial, emotional, creative, spiritual, environment/home.




* In the average week, this is how many days
I wake up happy or smiling:




* I am currently experiencing or being treated for:
 Alcoholism Drug Use Eating Disorder Diabetes
Allergies Headache Epilepsy Heart Disorder
Depression Cancer Immune Dysfunction Digestive Problems
Other:


My current religion or spiritual practice is:

 Agnostic/Believe in God
in general sense
Atheist/None
Baptist
Buddhist/Taoist
Catholic
Christian
Episcopalian
Evangelical
Greek Orth.
Hindu
Islamic
Interfaith
Jewish
Lutheran
Metaphysical/New Age
Methodist
Mormon/LDS
Pagan/Wiccan
Presbyterian
Protestant
Russian Orth.
Scientology
Shamanic/Indigenous
Spiritual but not religious
Sufi
Unitarian Universalist
Unity/Religious Science/
New Thought
Other:


Please check any of the following healing methods you are interested in:
couples counseling
hypnotherapy shamanic healing
individual counseling/coaching soul retrieval
energy healing, chakras, Reiki
angel/guide reconnection animal totems
meditation & guided imagery affirmations that work!
regression therapy (past-life and this life) chakra healing
opening third eye & ear to awaken intuition releasing work/cutting cords
spirit releasement, exorcism plant medicine
grounding techniques dreamwork
heart healings & meditations
psychic/intuitive reading and channeling prayer
letting inner child out (play, "sacred silliness") ritual


Please complete the following if you are interested in relationship coaching/counseling:

(If you are in a romantic relationship)

Describe your current relationship. You may wish to address thing like:
Do you feel she or he is a great match or are you uncertain? Describe your partner, degree of intimacy, length of relationship, commitment, any problems, and your satisfaction level. What techniques have you tried, individually and as a couple, to resolve issues (counseling, suggestions from self-help books, spiritual methods, etc.)? With what success? How can I support you both now?


OR (If you are not in a romantic relationship presently)

How do you feel about being "on your own"? Do you feel relieved, lonely, scared, angry, free, happy, sad, incomplete, complete? Do you feel like you have done enough letting go and healing? Are you clear about what you want in a relationship? Have you had unhealthy relationship patterns or poor choices of partners? Do you feel ready for love or do you feel you have some self-healing work to do, focusing on yourself for awhile?




MAIN ISSUE:
What issues or challenges are you facing right now? What have been long-term or lifelong challenge areas for you? What previous efforts have you made to solve these problems? What has worked, and what hasn't?




What attracted you to working with me?





Thank you. I look forward to working with you! - Rev. Taylor Kingsley, C.Ht.

Phone Sessions Only:
Click on your time zone:


Other

Please list below up to 5 possible times in the next week, in order of your preference, when you would be available for your session:




Initials:

Please initial above that you have agreed to our terms.
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LoveAndSpirit.org contents © Sage Taylor Kingsley-Goddard.
Website Design, Artwork & Layout © Mark Goddard.
Last update 2/7/10.