1:1 DBL Client Application

Prepare for the Journey of a Lifetime

Are you ready to dive deeper, are you ready to Discover Your Divine Bliss?
First of all, I just want to take the time to congratulate you for investing in yourself! This is a huge step! I know it’s hard to invest our money and time in ourselves, we tend to put every one and thing else above our own desires and needs. So, good for you for taking this huge step to discovering your divine bliss!
As a Spiritual Doula, it's important for me to understand how you view the world in general and yourself in particular. Each person has a unique way of thinking and a unique way of interacting with those around him/her.

Answer each of these questions as clearly and thoughtfully as possible, expressing the best of who you are. These questions are designed to better help me understand where you are in your life and where you want to be..
If you have any questions feel free to email DivineBlissLiving@gmail.com
Full Name*

First Name Last Name
Are you 18+?*

YesNo
Date of Birth*

MonthDay Year
Date
Your Time/Place of Birth is not required, however if we move forward in the coaching process it is very useful for Diving Deeper with your Birth Chart.
Place of Birth
City, State, Country
Time of Birth

Hour & Minutes Minutes

AM/PM Option
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail*
example@example.com
Phone Number*
Please note that all information (written or obtained during your session) is confidential.
Health History Please Check All That Apply Past/Current (notate any current issues in notes below)

Thyroid DiseaseAmneiaAllergiesAnxiety DisordersFood SensitivitiesHeart ProblemsInner Ear ProblemsDepressionAddictionHypoglycemiaCancerHeadachesJoint/Muscle PainAsthmaDiabetesEating DisorderClaustrophobiaOther
Current Medication & Dosage (herbal or pharmaceutical)
Are you interested in Sacred Plant Medicine?
What is most important to you in your life and why?
What are 1 - 3 main goals that you want to achieve in the next 3 months?
What do you wish to accomplish by working with Lauren?
How would you describe your spiritual beliefs, if any?
Check all that apply

I have experienced crystal healing beforeI have experienced a Reiki session beforeI have had an energy balancing session beforeI know about chakrasI have used holistic remedies beforeI have a spiritual path that I am consciously followI have experienced traumaI have difficulty adjusting to new situations and or peopleI am generally uncomfortable with touchI am generally uncomfortable expressing myselfI love myselfI accept myselfI am comfortable expressing myselfI feel like I belongI have experience with Sacred Plant Medicine
Is there anything else you want to share with Lauren?
Client Name (If minor, Name of responsible party)*
Relationship to the client
Signature of Client or his/her personal representative*

Clear
Date*

MonthDay Year
Date
This form has been created and will be confirmed by Restworldwide LLC, d.b.a. Divine Bliss Living

Divine Bliss Living
Wetumpka, AL
DivineBlissLiving@gmail.com
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Prepare for the Journey of a Lifetime