Intake form

Name *

Email address *

What are your main areas of interest in holistic regression therapy?

Please select at least one option.

Self-discovery

Personal growth

Emotional healing

Spiritual exploration

Life purpose

Overcoming fears

Trauma resolution

Have you previously experienced any form of therapy?

What specific goals do you hope to achieve through regression therapy?

How did you hear about us?

Are you currently experiencing any significant life changes?

Please describe any medical conditions or mental health issues that may be relevant.

Which service or services are you interested in?

Please select at least one option.

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Additional questions or comments

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