The Grace Session Application Form✨🌿
Thank you for applying. All responses are kept completely confidential. Please answer as honestly as you can. There are no wrong answers.
Applicant Information
Are you applying for yourself or nominating someone else?
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Please Select
Applying for myself
Nominating someone else
First name
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Last name
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Email address
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example@example.com
Phone number
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Please enter a valid phone number.
Format: (000) 000-0000.
Nominee Information
Nominee First Name
*
Nominee Last Name
*
Nominee Email Address
example@example.com
Nominee Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Nominee
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Application Details
Why are you nominating this person?
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In your own words, what are you currently going through?
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How is this affecting your daily life?
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Have you ever received holistic healing services before?
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Please Select
Yes
No
Not sure
What types of healing have you experienced, if any?
Are you currently able to pay for wellness services?
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Please Select
No, I am unable to pay at this time
It is very difficult right now
I can pay occasionally but it is a stretch
Would you like to share more about your financial situation?
Are you open to receiving energy healing, breathwork, and somatic wellness services?
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Please Select
Yes, absolutely
I am curious and open to learning more
I have some questions first
What do you hope to experience or receive from this session?
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Is there anything else you would like us to know?
Ongoing Healing Support
After your Grace Session, would you be interested in continuing with ongoing 30-minute healing sessions on a sliding scale ($5 to $25)?
Please Select
Yes, definitely
Maybe, I would like to know more
No, not at this time
What is the most you would be able to comfortably pay per session?
Please Select
$5
$10
$15
$20
$25
I am not sure yet
Is there a specific type of healing you would most want to continue with?
Agreements
Agreement 1
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I understand that submitting this application does not guarantee selection. One recipient is chosen per month and all applicants are treated with equal care and confidentiality.
Agreement 2
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I give Magical Moments Holistic Wellness LLC permission to contact me regarding my application.
Submit My Application
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