life shift & grief support Request

Thank you for considering our life shift & grief support. This form will help us understand your unique journey and healing needs. By providing us with some details about your life shift or transition, emotional state, and intentions for this healing experience, we can tailor our services to support you in the best way possible.

Your answers will remain confidential, and your healing process will be approached with care, compassion, and respect. Please take your time to fill out the form, and we will be in touch with the next steps.

Name

First Name

Last Name

Phone Number

(###)

###

####

Preferred Contact Method

Phone

Text Message

Preferred Consultation Date and Time

Your preferred dates and times for a consultation. This doesn't guarantee the date/time but allows us to schedule upon mutual availability.

What life shift or transition are you currently navigating?

(Grief, life changes, psychological shifts, etc.)

Have you experienced a significant loss or life-altering event recently?

(Please describe if comfortable)

What is your primary intention for this healing experience?

(E.g., releasing grief, embracing new beginnings, emotional healing, etc.)

How would you describe your emotional state right now?

(E.g., overwhelmed, lost, hopeful, etc.)

Do you currently have any support (e.g., family/friends, therapist, healer)?

Is there anything else you would like me to know about your healing needs or journey?

(Anything specific you’d like to share)

life shift & grief support Request

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