Personal Awareness Form

First of all, thank you for sharing your intention to raise your energy and improve your life with us.

To begin this journey with greater awareness, we kindly ask you to answer the questions below.

Awareness is the key to transformation.

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About You

Personal Information

Family Story

Family Background

Please specify her age in years and months (e.g., 28 years, 4 months).

Please specify his age in years and months (e.g., 31 years, 2 months).

Please include any miscarriages, stillbirths, or deceased children when determining your birth order. If your birth order differs on your mother's and father's side, please explain.

Briefly describe that person's life. For example, if you are the second child, who is the second-born among your mother's siblings? Is it your mother, your aunt, or your uncle? If applicable, please also take miscarriages and deceased children into account when determining birth order.

Is it your father, your aunt, or your uncle? Please briefly describe that person's life.

Before Your Birth

Pregnancy, Birth & Early Years

Before you were born, did your mother ever lose a child or have a miscarriage?
While your mother was pregnant with you, did she experience any traumatic event?
While your mother was pregnant with you, did she experience high levels of anxiety, emotional distress, or stress?
While your mother was pregnant with you, were there any problems in your parents' relationship?
Were there any complications during your birth?
Were you born prematurely?
Did your mother experience postpartum depression after giving birth?
Were you separated from your mother shortly after birth? If yes, why?
Were you adopted?
During the first three years of your life, did you experience any trauma involving your mother, or were you separated from her?

For example, did you spend time in an incubator, or did you or your mother experience a medical condition that required separation?

During the first three years of your life, did your mother experience any traumatic event or emotional turmoil?
Was your mother's attention and care significantly diverted to one of your siblings because of a traumatic event?

For example: miscarriage, stillbirth, death, an accident, or a serious medical condition.

Present Day

Concerns, Patterns & Wellbeing

Do you have any phobias or fears?

If your answer is Yes, please specify. If you have more than one, please list all of them.

Which color(s) are you naturally drawn to and enjoy seeing?

If so, please include their name (and middle name, if applicable) and indicate when it occurred.

If applicable, please indicate the age at which you were diagnosed or treated.

Inner Awareness

Identity, Dreams & Energy

Do you like your name?

Please provide only their first name and middle name (if applicable).

Please provide only their first name and middle name (if applicable).

Please provide only their first name and middle name (if applicable).

Please provide only their first name and middle name (if applicable).

Your Session

Experience, Questions & Intentions

Have you ever participated in a past-life regression session or any type of healing work? If yes, how did it affect your life?
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Confidentiality

Unless otherwise required by law or by competent legal authorities, all information shared with our consultants—including the information you provide in this form—will be kept strictly confidential.