✨ Answer honestly and intuitively—there are no right or wrong answers here. ✨
The Beginning of Your Healing Journey
Please answer honestly — this helps me understand if we are the right fit to work together.

Estimated Completion Time: About 10 minutes
🔒 Important: I do not open email attachments. All information is transmitted only through secure forms on my official website.
1. What is the main issue you want to resolve right now?
2. How long has this been affecting you?
3. What have you already tried to fix this? (Therapy, coaching, medication, etc.)
4. What is still not working?
5. How long has this been affecting you?
6. How does this issue affect your daily life or relationships?
7. What would your ideal state look like?
8. Are you ready to work on the root of this issue (not just talk about it)?
9. This work requires commitment and personal responsibility. Are you ready for real change?
On a scale of 0 to 10, how intense are the emotions you currently experience?
Anxiety
Not at all
Very Strong
Guilt
Not at all
Very Strong
Sadness
Not at all
Very Strong
Anger
Not at all
Very Strong
Hopelessness
Not at all
Very Strong
Resentment
Not at all
Very Strong
Fear
Not at all
Very Strong
Shame
Not at all
Very Strong
Loneliness
Not at all
Very Strong
Self-doubt
Not at all
Very Strong
Exhaustion
Not at all
Very Strong
Jealousy
Not at all
Very Strong
Have you experienced any of the following conditions or issues in the past?
*Select one or more options
Have you previously participated in hypnosis sessions?
Willingness and the roots of the issue
Are you ready to sincerely and completely release emotional and energetic blockages?
In your opinion, are the roots of your issue related to…
*Select one or more options
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