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Welcome to the

CEREMONIAL CHAKRA ENERGY BODY FREQUENCY HEALING & ATUNEMENT

Let's get to know each other a little more before we embark on this HEALING journey together!

First, Middle and Last Name*

Email*

Phone*

Mailing address*

Birth details (date, time and location)*

What interests you about the CEREMONIAL CHAKRA ENERGY BODY HEALING & ATUNEMENT?*

What kind of healing transformation are you looking to experience through this process?*

Occupation, Relationship and Family Status*

Please state all therapeutic or wellness processes supporting you at this moment in time. This can be psychotherapy, body-therapy or any other form of healing service. *

Are you taking any medications?*

If so, for what purpose?*

Do you experience any physical or emotional problems or symptoms at this time?*

Do you have any allergies and other chronic conditions?*

Have you experienced any of the following?*

What is your recent level of self-love?*

Do you have a spiritual foundation in your life?*

Please describe your spiritual foundation.*

Are you currently working in a shamanic or mediumistic tradition?*

In your own words, please describe all the symptoms and challenges you are currently experiencing in your life and how would you like things to be different?

Describe the current state and awareness of your energetic body? *

What else would you care to share with me that you feel may be relevant?*

What are your preference for appointment times and/or days?*

Would you like to be added to our email list?*

Referred By*

Payment Method*

submit above and then pay below

Additional Payment Options:

Pre pay with cash

Cash App $BryanCampbell0763

PayPal (friends & family) @bryancampbell0763 

Venmo (friends & family) @Bryan-Campbell-9

Zelle bryan0763@gmail.com

Gift card: Walmart, Publix or Amazon

Trade/Barter: services or items

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