First Name *

Last Name *

Email *

Phone *

Date of Birth *

Time of Birth (Enter exact time if known. Approximate time of day is OK.) *

Place of Birth *

On a scale of 0-5, how serious are you to improve your situation in that area of your life? 0 meaning “Not at all” AND 5 meaning “I want it gone yesterday” *

Please explain how come you picked that number and not a lower number *

Tell me about the other areas of your life. Give them a number below from 0-5 (0 meaning “can’t get any worse” and 5 meaning “can’t get any better”) *

Health
Fitness
Family
Relationships
Career
Finances
Peace of mind
Harmony in life

Are you seeking Healing? *

Yes

No

Are you seeking Coaching? *

Yes

No

Are you seeking Subconscious work for emotional freedom? *

Yes

No

What are you struggling with and want changed now? *

How long has this been a challenge in your life? *

What action steps have you taken to overcome those challenges? *

Are you under the care of a doctor/psychologist/psychotherapist? *

Are you taking any medication for your challenges? *

Are you working with another healer, hypnotherapist, or coach right now? *

Have you worked with a healer, hypnotherapist, or coach in the past? *

For things to change, you need an open mind. Are you willing to remain open? *

Yes

No

Are you coachable? *

Yes

No

During your session, are you able and willing to remain vulnerable and honest with me? *

Yes

No

This time together is sacred. Can anything get in the way of your showing up for this Strategy Session? *

Anything else you would like me to know?

Thank you, my dear, for your time and answering every question.

Click the "submit application" button, and you will be taken to a calendar to book your session.

Until later, Love, Peace, and Blessings, ♡ Coach Keya