session intake

Client Information

Thank you for filling out our one on one session intake form.
Your information is completely confidential and only used to support you during our session.

SET ASIDE SOME QUIET TIME FOR YOURSELF TO MEDITATE AND ANSWER A FEW QUESTIONS BELOW THAT WILL ASSIST YOU IN EXPLORING YOUR INTENTIONS AT YOUR SESSION. PLEASE GIVE IT YOUR FULL 100% ATTENTION AND ANSWER THE FOLLOWING QUESTIONS WITH AS MUCH DEPTH AS POSSIBLE.

ARE YOU READY FOR TRANSFORMATION? YOU WILL RECEIVE WHAT YOU PUT IN. PLAY FULL OUT!

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you find out about Xochitl Ashe? *

Age *

Birthday *

Birthplace *

Marital Status *

Single Married Divorced Widowed

Do you have children *

Yes No

Occupation *

Religious Preference *

What moved you to sign up for a Session with Xochitl Ashe? *

What are your specific intentions for your Session? *

Tell me about what you feel your purpose in life is. *

What do you feel your unique gifts are? Describe. Explain. Elaborate *

In your ideal world, what would you like to learn to receive the most value from Xochitl Ashe in your Session? Please be specific. *

List all specific questions you would like Xochitl Ashe to address for you during the Session. Be specific. *

What issue do you struggle with the most in your life and why? Write in detail. *

Where do you envision yourself in 5 years? Describe in detail. *

What do you feel is in the way of stepping into your next level of giving your gifts? *

How do you envision using what you learn about yourself in the Session in your Life? *

Health Questions

Have you previously experienced energy, Shamanic healing, Coaching or any other therapeutic healing modality? *

Name of Present physician and/or health practitioner, Coach or Therapist *

Do you have any physical disorders, metal health or health problems? Or history of them? *

Please list all previous major Illnesses, surgeries, hospitalizations and injuries and the year of occurrence. *

Are there any residual effects? *

Do you exercise regularly? If so, what form? How often? *

Do you smoke, drink or use any other form of mind altering substance? If so what, and how often? *

Are you currently on any form of medication, vitamins? If so, what type? *

Is there anything else that you think I need to know, or that you would like to share? *

Submit

Session Intake form

Client Information

Health Questions