Sacred Ode to Gaia Consultation Questionnaire
Share what you’d like your paid consultation to hold, and choose the service focus so we can tailor the questions to your request.
Client Details
Full Legal Name
*
First Name
Middle Name
Last Name
Name to Use
*
Pronouns
Please Select
She/Her
He/Him
They/Them
Ze/Hir
Other
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Phone call
Text message
Are you 18 years of age or older?
*
Yes
No
Consultation Date and Time
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Preferred Consultation Format
*
Zoom/virtual only
Common Questions
What is bringing you to this consultation now?
*
What would you most like to understand, explore, acknowledge, or create space for?
*
What would make this consultation feel useful even if no further service is offered?
*
What subjects or practices must not be included?
*
What spiritual, metaphysical, ancestral, cultural, religious, family, or personal language should be respected without being assumed?
Accessibility, communication, mobility, sensory, captioning, or scheduling accommodations
Preferred pace
*
Gentle and spacious
Balanced
Focused and direct
Unsure
Anything else the Founder should know before the consultation?
Intuitive Spiritual Advisory
What area of life or spiritual reflection currently needs the most clarity?
*
Are you seeking a single focused advisory session or ongoing one-to-one spiritual guidance?
*
Single focus
Ongoing guidance
Unsure
Which areas may be relevant?
Spiritual reflection
Ancestral wisdom
Energy awareness
Intentional living
Life transition
Discernment
Personal intention
Nature connection
Other
What would supportive guidance feel like to you?
What would feel too directive, intrusive, or certain?
Preferred meeting rhythm if ongoing
Weekly
Every two weeks
Monthly
Unsure
Shamanic Services
Which areas would you like to discuss?
*
Ancestral reflection
Past-life exploration as spiritual reflection
Energy-centered ritual
Intuitive guidance
Private ceremony
Spiritual transition
Nature connection
Other
Which area is most important?
*
Ancestral reflection
Past-life exploration as spiritual reflection
Energy-centered ritual
Intuitive guidance
Private ceremony
Spiritual transition
Nature connection
Other
Are there ancestral, cultural, community, family, or personal boundaries that must be honored?
Are there objects, names, traditions, symbols, sounds, scents, gestures, or practices that must not be used?
Preferred approach
*
Reflective conversation
Private ceremony
Energy-centered practice
Nature-centered practice
Unsure
What would feel too certain, frightening, directive, or intrusive?
Unsure
Briefly describe what you are hoping to receive
*
Which descriptions feel closest to what you need?
Intuitive Spiritual Advisory
Shamanic Services
Private Spiritual Journeys
Not sure yet
Consultation note
Required Understanding
I understand the $75 consultation is a separate, non-refundable service except where required by law.
*
I understand
I understand a consultation does not guarantee acceptance, availability, a proposal, a particular service, price, or outcome.
*
I understand
I understand any custom service requires a separate written proposal, payment, required agreements, and scheduling.
*
I understand
I understand these are spiritual and metaphysical services, not medical care, mental-health treatment, psychotherapy, diagnosis, crisis care, legal advice, or financial advice.
*
I understand
I retain personal agency and may pause, decline, modify, or end any activity.
*
I understand
I understand silence, uncertainty, or lack of objection is not consent.
*
I understand
I confirm the information is accurate to the best of my knowledge.
*
I confirm
Signature
Full Name
*
First Name
Middle Name
Last Name
Electronic Signature
*
Signed Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Private Spiritual Journeys
A personalized spiritual experience supporting exploration and integration, distinct from conversational advisory and specialized shamanic ceremonial or ancestral work.
What would you like to experience or explore?
*
What practices feel aligned for you, or would you like to avoid?
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