1:1 Mentorship *INITIATORY CHAMBER INTAKE FORM*

NOTE: This Form is for PRIVATE 1:1 MENTORSHIP (which includes access to the GROUP MENTORSHIP & commUNITY located on Circle)

GROUP MENTORSHIP Access Includes:

Access to all commUNITY Spaces in the Chamber designated for Sacred Sisterhood with women who are all on the Journey to INNER UNION and EMBODIMENT! We are committed to PARADIGM SHIFTING, leaving no stone unturned, we talk topics related to UNIFICATION and PURIFICATION of the SOUL.
Channeled Messages/Guidance/Prompts specific for the Group
LIVE TEACHING CALLS w/ Q&A
commUNITY Calls
Random Giveaways!
Exclusive Discounts on my (full priced) Services!
Access to Masterclasses & Resources!

***Payment links for Venmo & CashApp will appear after you click Submit! If paying in full with Credit Card, please enter payment info at the bottom of this form. If paying in installments, see me for links!***

Name*

First NameLast Name

Email*

example@example.com

What is a pattern/behavior you have broken/dissolved recently (or at least have the AWARENESS of, even if you don't feel it is dissolved YET)?
* .

Do you AGREE that you will NOT receive energy work from others while in my Containment? (Doing so can compromise the Work that we do)
* .

What is your most prevalent Pain Point / Issue in your life right now?
* .

What is something you really LOVE about yourself? * .

What is something that you feel SHAME or GUILT around? (an event, topic, trait, desire) *

Are you WILLING to ALLOW for the shattering of the beliefs that veil your authentic Self? *

Please include ANYTHING else you feel would help me to know about you! *

*Group Mentorship includes Access to Masterclasses! 😍

🌹 Which 1:1 Mentorship Package are you purchasing today?*

🌹 PLEASE PROVIDE MAILING ADDRESS TO SEND YOUR SIGNATURE POTION "CONVERGENCE" 10ml roller bottle! (This CODED Essential Oil Creation is INCLUDED in all Mentorship Packages)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

~ THANK YOU FOR THE OPPORTUNITY TO SERVE YOU! ~

CASH APP & VENMO PAYMENT LINKS WILL APPEAR ON NEXT PAGE AFTER YOU CLICK SUBMIT. OTHERWISE, PLEASE ENTER CC INFO BELOW!

I WILL REACH OUT TO YOU VIA EMAIL UPON RECEIPT OF PAYMENT. IF YOU HAVE ANY QUESTIONS, PLEASE REACH OUT shadoworacle@cosmicheartreverb.com!

CREDIT CARD PAYMENTS ONLY (IF PAYING VIA CASH APP OR VENMO, PLEASE LEAVE THIS SECTION BLANK, CLICK SUBMIT AND PAYMENT LINKS WILL APPEAR ON THE NEXT PAGE! PLEASE SEE ME FOR PAYMENT PLAN OPTIONS LINK!)

USDMENTORSHIP PACKAGE AMOUNT ABOVE

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