Custom NeuroTransform Meditation Individual Questionnaire

Name

First NameLast Name

Email

example@example.com

Who is this recording for?

If this recording is for someone else, please only share personal details you have permission to share and that would feel supportive for them to hear in a recording.

How experienced are you (or the gift recipient) with meditation and/or guided imagery?

What would you like this recording to support? (You can choose more than one.)

Other (please describe)

What is your main goal or intention for this recording? Please describe what you most hope this meditation will help with, and any specific situations or events it should support (e.g., upcoming performance, major life change, specific loss).

Are there specific emotions, challenges, or themes you want to focus on? (e.g., fear, grief, overwhelm, pain, burnout, self-doubt, loneliness, motivation, etc.)

How would you like to feel by the end of the meditation? (For example: calmer, more hopeful, focused, empowered, connected, lighter, etc.)

What name (or words) would you like used in the recording, if any? (For example: your first name, a nickname, the gift recipient’s name if this is for someone else, pronouns, or “you” language only.)

Which voice would you like for your recording? (View options by following the link below)

Listen to voice options here

If you have any notes about pace or tone you prefer, please share them here. (For example: slower or faster pacing, more pauses, slightly softer or more energizing tone.)

Which background audio would you like for your recording? (View options by following the link below)

Listen to music options here

If you chose “I have a specific request,” please describe what you have in mind. NeuroTransform will review this with you and let you know what’s possible. Custom or specially licensed music may involve an additional fee.

At the onset of the recording, what would you prefer?

Which types of imagery or environments tend to feel most calming or supportive for you? (You can choose more than one.)

Other

If you’d like, share any specific details or preferences about your imagery (e.g., 'ocean at sunset,' 'forest in winter,' 'cozy cabin with a fireplace,' etc.).

How would you like to handle affirmations?

If you have specific affirmations, please list them here. You can also use this space to share any phrases, themes, or values that feel especially important to include.

Is there anything NeuroTransform should avoid or keep in mind to make this recording feel safe, supportive, and accessible for you? For example: words, topics, or styles of language that don’t feel right for you, things that haven’t worked well in past meditations (very long silences, counting, certain imagery), sensitivities to specific topics, spiritual framing you do or don’t want, anxiety around breath cues, trauma‑related considerations, sound sensitivities, or any accessibility needs.

At the end of your meditation recording, would you like NeuroTransform to briefly suggest a few optional journal prompts you can explore afterward?

Do you have a preferred approximate recording length? NeuroTransform will recommend a length based on your goals and how you’d like to use the recording, but it helps to know if you have any preferences.

If you chose 'I have a specific timing/length request,' please describe what you have in mind. Note: Recordings longer than 30 minutes may involve an additional fee; if that’s the case, NeuroTransform will confirm with you before moving forward.

Before NeuroTransform records your audio, would you like the option to review a draft script?

Typical timing works like this: once NeuroTransform has your completed questionnaire and payment, you’ll usually receive a draft script within about 5 business days (if you’ve chosen that option), and after you approve it, your final audio recording is typically delivered within another 5–10 business days. Do you have any timing preferences or important dates we should be aware of?

This form is hosted by Jotform, a third-party form platform used by NeuroTransform to collect form submissions. By submitting this form, you understand that NeuroTransform provides custom guided meditation recordings and wellness, educational, coaching-style, and guided imagery support only. NeuroTransform does not provide medical care, psychotherapy, diagnosis, treatment, crisis services, or emergency support. Please do not submit urgent, crisis-related, diagnostic, or highly sensitive medical information through this form. If you are experiencing a medical or mental health emergency, thoughts of self-harm, or a crisis, do not use this form. Call 911, 988, or seek immediate help from a qualified professional or emergency service. Information you submit will be used to respond to your request, develop your customized meditation recording, and communicate with you, consistent with our Privacy Policy.

For more information about how NeuroTransform collects and uses information submitted through this form, please review our Privacy Policy.