Vital Essence Questionnaire

Vital Essence Questionnaire
Please complete the questionnaire with as much detail as you can, this provides Renée with some background knowledge of your current circumstances and history.

The information you provide is strictly confidential and is only shared with Renée Longworth for the purpose of creating your Vital Essence.

Once completed and submitted, this form is sent to Renée Longworth and also returned to the email address that you have provided. Please ensure that the email address you provide is your personal email address to ensure your confidentiality.
Gathering information.

In order to create your Vital Essence, specific and accurate information needs to be gathered which is then calculated and mapped out in template form.

You have your Vital Essence blueprint for life; since your birth, and will never change. After I have personally calculated all your information, I then get to work creating your personal remedy that will become the essence you will be working with to help shift you into your natural state of your soul's purpose.

Remember, that it's important to seek support when you feel it necessary, either professionally and/or through family and friend networks. The process may feel a bit bumpy and emotional for the first week or so, until your energy will stabilise and you may then start to feel more vitality, start to process and return to the flow on effect towards your purpose.
Full Name

First NameLast Name
Mobile Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
Personal Information required
Date of birth

MonthDayYear
Date
Western Astrology - your Zodiac sign
Name that you were given at birth (not a married name or changed name)

First NameLast Name
Country you were born in
Current circumstances
What is your prime intention for using this remedy? What do you wish to achieve?
Do you feel like you know what your Soul's purpose is? And if so, what is it? Or are you in confusion in regards to your direction?
Please describe the challenges you feel are present regarding finding, living, expanding or reaching your Soul's purpose.
Physical, mental and emotional
Please describe how the challenges or confusion are making you feel. What are the main emotions that are present.
Are you holding onto to any fear in regards to living or finding your Soul's purpose, if so, what do you feel they are? Also, do you have any fear regarding taking this remedy, please describe.
Do you have any physical challenges, illness, conditions or disease in your physical body. Please describe.
Do you have a diagnosed mental health condition? If so, is it currently 'active'. Please describe.
Do you have any repetitive negative self talk? And if so, what are some of the statements that you are repeating to yourself?
Is there anything else you wish to add, which you feel is important and relevant to this process.
Thank you for being open and vulnerable with your answers.

All this information is important to your process. Even writing out your answers will start your shift as you have now instigated the process.

I'll be creating your personally prescribed Vital Essence remedy soon, and let you know when it is ready to post to you.

Thank you! Renée xx
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Vital Essence Questionnaire

Personal Information required

Current circumstances

Physical, mental and emotional