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XByCC Intentional EarthCare Jewelry Assessment
1
Image Field
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2
Date of Birth
-
Date
Year
Month
Day
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3
What colors are you drawn to?
Blue
Red
Green
Pink
Yellow
Black
Brown
Gold
Silver
Orange
Purple
Black
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4
What would you like to Improve?
Creativity
Energy
Intuition
Prosperity
Tranquillity
Focus
Emotional Trauma
Electromagnetic Frequency Protection - Radiation, Wifi, Bluetooth, 5G
Thinking & Brainstorming
Love
Confidence
Spirituality
Sexuality
Positivity
Other
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5
What area are you looking to aid?
Stress
Love
Peace
Negative Energy Protection
Depression
Manifestation
Energy
Meditation
Chakras
Sleep
Psychic Abilities
Electromagnetic Frequencies - Radiation, Wifi, Bluetooth, 5G
Pain
Inflammation
Sobriety
Pregnancy
Positivity
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6
What would you like to Dispel?
Anxiety
Fear
Depression
Anger
Pain
Doubt
Negative Energy & Bad Vibes
Emotional Trauma
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7
Which areas are you aiming to Focus on?
Grounding Self
Centering Self
Aligning Self
Restoring Self
Transitioning Self
Spirituality
None or Not Sure
Positivity
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8
Anything big or small happening in your present or near future? Any Feelings, Obstacles or Situations that you would like to address? Anything on yo heart?
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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9
Which Suggestions would you like emailed?
XByCC Original EarthCare Jewelry
Custom XByCC EarthCare Jewelry
Both
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10
Email
example@example.com
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