Life Mentoring Program Intake Form Your First Name: Is Pronunciation of First Name: Standard? Unique? If so, please give pronunciation below Name Pronunciation: Last Name: How did you hear about this program? Name of the person who referred you so we can thank them! Life Mentoring Intention you are called to: Breakup Break Through Name Your Mission Growing Through Grief Prosperity Power Intuitive Alignment & Healer Support Name Your Mission here: Length of Program purchased: Single Session 90 or 120 Minutes 6 Sessions 12 Sessions You're doing great! Deep Breath! Now... what led you here? While you are working with Laura in the upcoming weeks, are there any other important things happening that could impact your scheduling? Are you currently under medical care that might impact your program work? Yes No Are you presently taking any medications including antidepressants, anti-anxiety or mood stabilizers? This is important for us to be aware of while we are working together, journeying & meditating. How soon do you wish to start? Are there any time sensitive things which might impact your scheduling? You may wish to schedule ASAP, or weekly due to a time sensitive goal you are navigating. Or you may have time constraints on your ability to meet. Do you have access to Zoom? (applicable only for Reiki Students) Yes No Cell Phone Number Are you open to receiving text messages of support from Laura occasionally? Heck, Yes! No, Thank you. If you would like to receive a Birthady audio from Laura, please list your birthday below: Anything else you would like Laura to know? Thank you. Upon submission, your form goes directly to Laura for review. If she has any questions we will be in touch with you! Please include your email below I consent to having my data collected & stored. Yes Send
