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Qi Spot & Zen Den Events
Are you ready to ENJOY your life more?
Yes
No
Name
*
First Name
Last Name
Email Address - IF AN EMAIL IS PREFERRED
example@example.com
Phone Number - IF A TEXT IS PREFERRED
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like more info about: (check all that apply)
Small Group Sound Bath
Movement as Medicine / Somatics / Yoga / Dance
Women's Circles
Sunday Morning Meditation & Message
Unique Insights / Learn More About You / Human Design
Ceremonies & Event Gatherings (i.e. Cacao, Moons)
LEARN MORE / SCHEDULE @ linktree.com/mellowatts
Please confirm that you DO NOT currently have any of the following:
Epilepsy Condition (Strictly Prohibited)
Infectious Skin Issue (Strictly Prohibited)
Heart Monitor or Valves / Pace Maker (Strictly Prohibited)
Recent Surgery or Metal Implant (Please Wait 6-12 Months)
I have NONE OF THE ABOVE
Skip Over the Calendar if you have Already Booked a Session!
Schedule a Session (IF YOU HAVE NOT ALREADY DONE SO):
Are you comfortable with touch? (touch is NOT required, but sometimes helpful)
*
Please Don't
Minimal touch might be OK, if it'll greatly enhance my session results
I am completely OPEN to appropriate and therapeutic touch, including feet, head & neck
I am open to touch with an EXCEPTION, please explain below:
Touch Exceptions:
Do you currently have a movement / exercise practice?
Yes, daily or almost daily
No, not at all - I'm fine tho
No, but I need to
Kinda, but I need more regularity
Are you interested in adjusting your eating habits?
Yes, I think I must
No, not really
Kinda, but I'm lost
Do you sleep well?
Yes, can't complain
No, and it might be a problem
Hit or miss - but I have bigger things to worry about right now
Do you include spirituality in your daily life: a morning or evening ritual perhaps?
Yes
No
Sorta, but not regularly
Do you have any concerns that you're comfortable sharing (physical, emotional, mind-matters):
Do you consider yourself any of the following, Faith-Based:
Christian
I appreciate all faiths (Universalist / Unitarian)
Spiritual / Non-Conformity
Eastern: Buddhist/Yogi/Hindu
Naturalist / Pagan
Jehovah's Witness
Muslim
Atheist
Agnostic
Astrology & Birth Charts are:
Against my faith and beliefs
I know my sign & read it casually for entertainment purposes only
Kooky Dumb B.S.
I might be a bit curious, but I'll have to feel it out
I'd love to know more about myself in relation to the cosmos
Sign me up for a FULL Birth Chart ($40) - (Answer the next 3 questions)
What is your date of birth, please:
-
Month
-
Day
Year
This is for astrological considerations & can be skipped
Where exactly were you born?
This is for an astrological birth chart & can be skipped
What time where you born? (Exact Time & AM or PM)
This is for an astrological birth chart & can be skipped
Please rank your interest in the following, if you're completely unsure about something, NEUTRAL is the best response:
Rows
1 - Not Interested
3 - Neutral
5 - Very Interested
Business/Success Coaching
- ESP. New Start Ups
Lifestyle Guidance /
Perspective Shifting
Wellness from food
- Diet changes
Purposeful Hypnosis:
(Diet / Smoking / Etc)
Reiki / Energy Healing
Meditation / Breath-work
& Daily Rituals
Yoga - Unique Flow 4U
SUNDAY MORNINGS -
Group Sessions:
Sound Bath followed by
a Matcha-Tea Ceremony
FRIDAY NIGHTS -
Group Sessions:
Movement as Medicine
& Sacred Cacao Ceremony
Injury Prevention / Longevity
& Strength Building for Men
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