Sacred Ode to Gaia — Private Spiritual Journey Questionnaire
Share your spiritual intention, pace, boundaries, and accessibility preferences before your paid consultation.
Client and consultation details
Full legal name
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Name to use
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Pronouns
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.
Preferred contact method
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Email
Phone call
Text message
Age confirmation
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Yes
No
Preferred consultation format
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Virtual on Zoom
Reason for reaching out
What led you to seek this Private Spiritual Journey?
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What meaningful space would you like this journey to hold for you?
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What feels most important for Demearria to understand before speaking?
Have you had a spiritual or energy support experience before?
Yes
No
Not sure
What has felt supportive, and what has not felt supportive, in past experiences?
Current season
Which words best describe your current season?
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Beginning
Transition
Uncertainty
Release
Grief or remembrance
Reconnection
Discernment
Spiritual awakening
Creative change
Rest
Other
What feels steady or supportive right now?
What feels unfinished, unclear, or difficult to name?
Mind, body, soul, spirit, and Earth check-in
These questions invite awareness rather than diagnosis. Medical details are not needed.
Mind (thoughts, questions, repeating patterns)
Body (sensations, rhythms, signals)
Soul (what feels personally meaningful, true, or deeply important)
Spirit (connection, distance, curiosity, or change)
Earth (nature, place, season, living world) and how these areas feel connected or out of rhythm
Spiritual and metaphysical focus
Areas you’d like to explore
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Spiritual clarity and discernment
A major transition or new beginning
Spiritual awakening integration
Intuitive development
Dreamwork and personal dream meaning
Ancestral reflection and remembrance
Energy awareness or chakra reflection
Shadow or inner-child spiritual reflection
Private ceremony
Nature connection and grounding
Other spiritual or metaphysical intention
Which area feels most important to begin with?
*
Subjects you do not want included
Preferred wording for this part of your journey
Spiritual
Metaphysical
Ancestral
Intuitive
Ceremonial
Nature-centered
Another wording
Religious, cultural, family, or personal beliefs to be respected
Dreams, intuition, ancestry, and energy
Do you have dreams, intuitive experiences, or symbolic messages you would like to explore?
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Yes
No
Maybe
Discuss first
If yes or maybe, please share any recurring themes, images, feelings, or experiences you would like to discuss.
Would you like to reflect on ancestry, heritage, lineage, chosen family, community, land, or culture in this journey?
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Yes
No
Maybe
Discuss first
If yes or maybe, what does ancestry or lineage mean to you, and are there any relationships, traditions, or communities you would like to include?
Would you like to explore your energy awareness or chakra reflection?
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Yes
No
Maybe
Discuss first
What language feels comfortable for discussing energy, balance, alignment, or related experiences?
Would you like to include shadow work or inner-child reflection?
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Yes
No
Maybe
Discuss first
What boundaries would help keep shadow or inner-child reflection emotionally and spiritually respectful for you?
Would you like a private ceremony or ritual to be part of this journey?
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Yes
No
Maybe
Discuss first
If yes or maybe, what meaning, transition, or intention would a private ceremony acknowledge?
What would feel too certain, directive, frightening, or intrusive for you in this process?
Are there any names, traditions, objects, practices, or cultural boundaries that must not be used?
Which ceremony elements feel welcome at this time?
Quiet reflection
Spoken intention
Breath awareness
Guided meditation
Sound
Natural objects
A candle or symbolic light
Writing
Movement
Silence
None until discussed
Other
Are there any ceremony elements that are not welcome or should be avoided?
Consent, boundaries, and accessibility
How should Demearria check in when approaching a sensitive topic?
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What signs tell us you need a pause, a slower pace, or a different direction?
What helps you feel grounded and able to make your own choices?
Words, gestures, touch, sounds, scents, imagery, or practices you do not consent to
*
Accessibility or communication accommodations needed
Sensory preferences
Quiet
Low lighting
Natural light
No fragrance or smoke
Limited sound
Frequent pauses
Camera off for virtual session
Written instructions
Other
For virtual sessions, do you have a private place and reliable internet?
Yes
No
Not sure
Not applicable
Journey preferences
Preferred pace
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Gentle and spacious
Balanced
Focused and direct
Unsure
Preferred journey length
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A single extended experience
Several sessions
A longer supported journey
Unsure
Session timing or scheduling limitations
Would Digital Sanctuary resources be welcome?
*
Yes
No
Maybe
Discuss first
Preferred resource formats
Written reflections
Audio meditation
Printable reflection pages used electronically
Digital affirmation or altar cards
Dream prompts
Grounding practices
Other
What would make the journey feel complete enough to close?
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Expectations or hopes to discuss during consultation
Anything else Demearria should know
Required understanding and electronic signature
I understand this questionnaire does not guarantee acceptance, availability, a particular journey design, or any outcome.
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I understand
I understand the $75 consultation is a separate one-hour service and is non-refundable except where required by law.
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I understand
I understand Private Spiritual Journeys are spiritual and metaphysical services, not medical care, mental-health care, psychotherapy, diagnosis, crisis service, legal advice, or financial advice.
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I understand
I understand intuitive impressions, dream reflections, and spiritual perspectives are invitations for personal reflection, not predictions, commands, or guaranteed facts.
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I understand
I understand I retain personal agency and may pause, decline, modify, or end any activity.
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I understand
I understand silence, uncertainty, or lack of objection is not consent.
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I understand
I understand services require a separate written proposal, payment, required agreements, and scheduling after the consultation.
*
I understand
I understand payments are non-refundable except where required by law and eligible cancellations may be rescheduled according to the applicable written policy and availability.
*
I understand
I confirm the information I provided is accurate to the best of my knowledge.
*
I confirm
I consent to complete and receive records related to this inquiry electronically.
*
I consent
Typed full name
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First Name
Middle Name
Last Name
Electronic signature
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Date signed
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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