Inner Healing Assessment
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Full Name
Is there a  Physical issue you want to repair, heal, or somehow fix? *
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If Yes, Please Explain

How deeply are you willing  to look  to “fix” the malfunction? or, do you just want it to gone without much effort?

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Are you convinced that someone other than you is responsible for the malfunction?

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Can you access the feeling or emotion relating to the issue without judgment?

Do you have feelings or emotions that upset you simply because you have them?

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How long have you been troubled by this issue?

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Is the issue recurring or chronic? *
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Does anyone in your family have the same issue?

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If Yes, Who specifically in your family?
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How much do you want what you say you want?

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Are you willing to put time, effort and considerable discipline in order to get what you want, even to the point of signing an agreement I can hold you accountable to?

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Preferred Email
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Would you like to be contacted via Phone?
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Required
Phone Number
Best time to contact?
Time Zone
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