Womb Awakening Consultation Form
For Womb Healing Sessions
Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
Age
What is calling you to explore womb healing at this time?
Are you on any medication*
Yes
No
Other
Have you ever suffered from or addiction, mental health issues or psychosis?
Yes
No
If yes, When?
Are you addicted to any drugs or any other substances at present?
Yes
No
Are you pregnant or planning pregnancy? Please note that this work is NOT appropriate for pregnant women as we will be doing some powerful womb clearing work.
Yes
No
Do you have any significant medical history that you’d like me to know about, particularly regarding your womb health, along with past sexual and reproductive issues?
Yes
No
How much experience do you have in doing holistic & energetic practices?
No experience
1
2
3
4
Fully experienced
5
1 is No experience , 5 is Fully experienced
Have you trained in any Spiritual or Energetic modality?*
Yes
No
Please confirm that you have answered all the questions truthfully and with utter honesty?
I agree
I dont agree
Submit
Should be Empty: