Spirit Walk Application Form

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End-of-Life Emotional and Spiritual Care for the dying and their loved ones.

Thank you for taking this loving step on your journey. Please fill out this application form so I can get to know you better. The next step will be a phone meeting together on the phone or in person to connect more deeply.

with infinite love and compassion,

Ashley

Which description best suits your situation:

I am seeking support on my journey of crossing over.

I am a family member / loved one of someone on a journey of dying and I need support.

I am submitting this request on behalf of someone who would benefit from your services.

Other:

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Name

Preferred phone number

Emergency contact person with phone number

How did you hear about my services?

Do you take any prescription medication? If so please specify.

If you have a medical practitioner that you would like to include as an emergency contact, please include their information here:

In a few sentences, please describe the situation surrounding your Spirit Walk Journey at this time. Including the main challenges you are facing that you would like to be supported through.

Every person's journey is so unique. Which of the offered services would be most supportive to you at this time?

I am interested in being emotionally and spiritually supported on a weekly or bi-weekly basis.

I am interested in family grief support and art therapy on a weekly or bi-weekly basis.

The crafting of a beautiful ceremonial celebration to honor my life or my loved ones after transitioning..

All of the above.

In a few sentence, please describe your relationship to aging, death and exposure to anyone dying before if applicable.

Do you have any religious beliefs of spiritual practices that are meaningful to you? Please describe.

Do you regularly suffer from any of the following:

Chronic Insomnia

Depression

Anxiety

This box is open to you if there is anything else you wish to share or if you have any specific questions.

As you know, these services are donation based as I care to be able to offer this to as many people as possible. Please specify if you are able to make any monetary contributions at this time.

Yes

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