top of page


Let's get to know each other a little more before we embark on this HEALING journey together!

Full Name (First, Middle and Last Name)*

Email Address*


Mailing Address*

Birth Details (Date, Time and Location)*

What service(s) are you requesting?*

What Interests You About the Spirit Clearing or Curse Unraveling?*

What kind of transformation are you looking to experience through this process?*

Occupation, Relationship and Family Status*

Please state all therapeutic or wellness processes supporting you at this moment in time. This can be psychotherapy, body-therapy or any other form of healing service. *

Are you taking any medications?*

If so, for what purpose?*

Do you experience any physical or emotional problems or symptoms at this time?*

Do you have any allergies and other chronic conditions?*

Have you experienced any of the following?*

What is your recent level of self-love?*

Do you have a spiritual foundation in your life?*

Please describe your spiritual foundation.*

Are you currently working in a shamanic or mediumistic tradition?*

In your own words, please tell me what is happening in your life?*

What challenges you are experiencing? *

What else would you care to share with me that you feel may be relevant?*

What are your preference for appointment times and/or days?*

Would you like to be added to our email list?*

Referred By*

Once you submit your application kindly continue to payment to complete your registration unless you are paying with cash. Cash is preferred.  

Both application and payment are required. And, if you haven't done so already get to know us HERE!

bottom of page