Request for Complimentary Meditation Session

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Thanks for requesting a complimentary consultation! These consultations are filled on a first come, first served basis, and openings and timings are limited. During this session we will get to know each other, talk about your goals, practice a special breathing exercise, then chat about what I offer.

Email *

Name *

How long have you been living with fibromyalgia symptoms? *

What is your age group? *

In your 20s

In your 30s

In your 40s

In your 50s

In your 60s or above

Do you work/volunteer/look after children... *

less than 10 hours a week

11-20 hours per week

21-30 hours per week

31-40 hours per week

more than 40

When are the best days/times for a chat via Google Hangouts? *

Friday afternoons/evenings

Saturday afternoons

Wednesday or Thursday evenings

Required

What is your timezone? (I'm Wellington, NZ) *

Do you wish to be included in the Melissa vs Fibromyalgia newsletter list to receive my latest posts, freebies and more? *

Yes

How did you hear about this session? *

I am on your newsletter list

I am in one of your Facebook groups

Your facebook page

I follow your blog

Other:

Required

Signature. Writing your name below confirms that the information you have provided is correct as you know it. *

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