PLEASE READ AND SIGN: *

First Name

Last Name

Birthday *

MM

DD

YYYY

Time You Were Born (am/pm?) *

Please just type in your birth time, do not worry about the time zone. Just mark your birthtime at the place you were born.

Hour

Minute

Second

AM PM

What Resonates With You?

What areas are you most wanting to explore, refine, or embody at this time?

Divine Timing & Success Codes

Leadership & Expression

Relationship to the Body or Health Pathways

Reconnection with Divine Source Identity

Business as Mission (Soul Business)

Galactic or Interdimensional Remembrance

Energetic Clean-Up / Field Clearing

Quantum Wealth & Receiving Flow

Soul Purpose & Soul Confidence

Other

Children? *

Do you have children?

Yes

No

Where are you right now with your goals?

Which of the following feels most true for you right now?

I’ve been activating a new layer of purpose and am ready to ground it.

I feel a breakthrough on the edge of my field and want support clarifying or stabilizing it.

I’ve come a long way, but something subtle keeps limiting full embodiment.

I’m hearing the call to step into a new leadership frequency.

I’m ready to see what I couldn’t see before and walk through a new door.

Every phase is sacred, even when we feel lost or uncertain about the answer, if none of the above feels like the right answer, please fill in the blank and share where you are.

Consent Signature *

⚪PLEASE READ AND SIGN:⚪ Thank you for choosing to enter this sacred work. This is not just a session—it is an initiation. Before we begin, I invite you to align with the following terms of participation. These words serve as our energetic agreement, rooted in clarity, sovereignty, and mutual devotion to your evolution. ⚪ This Work is Not a Substitute for Medical Care The energy modalities and soul-based practices offered here—including soul coaching, regression, meditative journeying, energetic attunement, and remembrance activation—are powerful catalysts for transformation. However, they are not designed to diagnose, treat, or replace licensed medical, psychological, or psychiatric care. ⚪If you are under the care of a healthcare provider, please continue to follow their guidance alongside this work. Your physical and emotional well-being are sacred—and you are always your own best advocate. ⚪ Client Acknowledgment By signing or submitting this form, I affirm the following: – I understand that I am a co-creator in this journey, and my level of presence, willingness, and honesty shapes the depth of what unfolds. – I recognize that all outcomes are unique, and no specific result is guaranteed. – I acknowledge that this work is spiritual and energetic in nature, and is not intended to replace medical treatment or mental health care. – I take full responsibility for my choices, emotions, thoughts, and actions—during and after the session. – I understand that my free will is always honored. I may pause or end the session at any time. – I agree to respect sacred timing, including punctuality and a 24-hour notice for cancellations or reschedules. – I trust that all shared experiences are held in deep confidentiality, including for youth participants (with ethical guidance observed). – For in-person sessions, I consent to gentle, non-invasive touch if needed for grounding or guidance (e.g., hand, shoulder, wrist, forehead). ⚪ Empowered Participation - I choose to enter this field: – In full responsibility for my energy. – Willing to see what is ready to be revealed. – Open to shifting what no longer serves. – With respect for the sacred nature of this space and the guidance shared. “I walk in awareness. I co-create in freedom. I am ready to remember why I came.” E’stA Un’TA E’-Sa – So it is. Always.

First Name

Last Name