Blog - I AM Elementals

Name

Email Address

Phone

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Date of birth, time, location:

I give Amanda permission to analyze my birth chart. ("No" is a totally acceptable response and you will still have an amazing and transformative session regardless of answer here).YesNo

Occupation

Marital Status

Do you have children? If yes, how many?

Perceived Stress Level (0-10)

Please list any medications you are currently taking, with dosage and how long you've been taking them:

Current Vitamins/Supplements: Please Include dose (amount/freq/time of day) + how long you’ve been taking it:

Do you have any food sensitivities or allergies? If so, please elaborate:

What is your current eating pattern/schedule?

Do you have a specific way of eating? i.e. vegan, vegetarian, paleo etc.

Do you consume alcohol? If so, what is your intake per week? Any other drug use?

Please list any current health issues:

Please list any previous medical, surgical or health issues:

What is your blood type?

How would you describe your sleep patterns? How many hours on average do you sleep a night?

How would you describe your digestion?

Do you have bowel movements regularly?

How often do you exercise per week? What do you do for exercise? Do you enjoy it?

Please provide brief outline of what've been experiencing and would like to transform

What makes it worse?

What makes it better?

How will your life be different when this is transformed?

What are your expectations of this session?

Is there anything about your situation that would be helpful for me to know?

Have you ever suffered a head injury that resulted in loss of consciousness or brain trauma?

Have you received in-patient psychiatric treatment, and if so: what, where and for how long?

Please list your hobbies and interests:

What do you feel stops you/your health/your goal from changing?

What will be different once you/your health have changed?

How will this change affect your quality of life and relationships?

What has been your best accomplishment to date?

What does optimal Well-Being mean to you?

Do you have a morning and evening ritual or practice? If so, please elaborate. If not, are you interested in creating one?

Do you currently meditate? What's your experience with meditation?

Have you ever tried hypnotherapy before? If so, what was your experience?

If you could change and transform ONE thing, what would it be?

What’s your intention for this session?

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Sunset Meditation