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Transformational Healing Form

In order to connect with your energy, I do need some personal information from you. I also need to know what you want to work on.

Although you may experience shifts in many areas, it is best to focus on one thing that you would like to transform.

Healing Form
Please note that all fields followed by an asterisk must be filled in.
First Name*
Last Name*
E-mail Address*
Street Address
Zip/Postal Code
Home Phone
Birth date*

So that my own mind doesn't get in the way of your healing/transformation, I only need a small amount of information to find the underlying patterns that have caused a problem and send healing. If you want to share more, that is fine too.

After I receive this information, I will schedule a time to do the energy work and send you a transcript of the reading after the session is complete. You will likely start to see shifts as soon as you complete this form so be sure to notice what's different.

Problem / Challenge:

Although manifestation of what you want may be accomplished simply by healing the patterns that keep you away from it, setting an intention for the session will help me to find the patterns that are in alignment with your desire. Most likely this will be the opposite of the "problem". In other words, if "lack" is your word for above, "abundance" may be the word you use here.

One word or phrase to describe what you want:

If you have not already purchased your session, you can do so here. Your session will be performed at a distance Monday - Friday between 1:00 and 5:00pm, EST, although you will start to see shifts even before your scheduled session.


Please enter the word that you see below.