The Holistic Healer Application Form
Hello Beautiful Soul~
I'm SO happy you landed here!

Please take 15-30 minutes to complete this form. It will give me an opportunity to get to know more about you, your dreams, and your goals so that I can best support YOU!

I'm excited to embark on this adventure together and look forward to you taking your first, yet MAJOR step towards your healing journey.

Please allow between 24 to 72 hours for me to respond to your inquiry. 

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Email *
Full Name: *
Preferred Pronouns:
Email: *
Phone Number: *
How did you hear about Embody Lotus & Bloom? *
If "Other" above, please specify the source. *
I am most interested in: *
Tell me more about you! What are some areas that are super challenging for your right now? What is going well for you? *
What are some of the goals that you wish to accomplish during our work together?
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Where are you located? Please provide your time zone. *
Have you received therapy, counseling, or coaching before? If so, tell me about your experience. *
How do you learn best? *
Where do you mostly hang out, on social media? *
What is getting in the way of accomplishing your goals right now? Please share some barriers. *
On a scale of 1-10, 10 being extremely important and 1 being not at all, how important is it for you to solve these challenges so you can get your life to where you want it to be?
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What is the cost (emotionally, financially, physically) if these challenges continue?
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Describe what you'd like your life to look like 12 months from now.
*
Why is now the perfect time to make these changes?
*
If your life was a book, what would the title of your chapter be, to describe your life right now and why? *
What else is important for me to know? *
By submitting this form I am agreeing to receive automated communications from The Mama Sanctuary, LLC/Embody Lotus & Bloom.
I also understand I can unsubscribe at any time.
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