Holistic Healing Services Client Questionnaire

Aiesha Cosmos Application Form

Please fill out the following application form, once completed and reviewed. You will be notified if it is approved.

Question Title

* 1. Which of the following services are you interested in? Select all that apply

Maya Reading

Oracle Reading

Relationship Coaching

Spiritual Guidance

Ceremonial Work

Other

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* 2. Have you invested in your healing and personal development before?

Yes

No

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* 3. What personal development or healing work have you engaged in?

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* 4. How important is it for you to realize your life mission?

Not important

Somewhat important

Important

Very important

Extremely important

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* 5. How ready are you to make lifestyle changes?

Not ready

Somewhat ready

Ready

Very ready

Extremely ready

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* 6. How much time can you invest in your personal transformation each week?

Less than 1 hour

1-3 hours

3-5 hours

5-10 hours

More than 10 hours

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* 7. What are your main priorities in your personal life?

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* 8. How prepared are you to let go of relationships you can no longer serve?

I am ready to let go of relationships I am no longer able to serve.

I am unsure if 'm ready to let go.

I am not ready to change anything.

Question Title

* 9. Do you have time for a one on one interview call with Aiesha?

Yes

No