Coaching | Monique Elouise | Anahata Ascension | Psychic & Spiritual Development

Client Information | Coaching, Mentoring & Healing

Please fill out this form as best you can so I can provide you with the most relevant tools, training, and techniques to empower you on your journey forward. My role as a coach, healer, & mentor is to hold space for you as you grow, holding you accountable to take inspired action, and helping you shift through energetic 'blocks' that may arise with the power of energy healing, psychic guidance (as needed), somatic therapy techniques, and mindful questioning to help guide you forward.

Please note that I am not a qualified counsellor, medical doctor, or above, and do not make any promises to 'heal' you. Rather, I hold a supportive space for you to move forward with the magic of energy alchemy and psychic guidance, so you can manifest the life you desire, with ease and grace. Let's transform and manifest!!!

First name

Last name

Email

Phone

Birthday

Day

Month

Year

Address

Marital status, children, and partners name

Occupation

Yes, subscribe me to your newsletter.

Choose 1 to 3 areas from the below list that you feel need the MOST attention:

What has made you want to reach out and work with me now?

Are there specific things about these key areas that you know you want to change?

What would you gain from making changes to these key areas?

What would you loose from making these changes?

Reflecting on the last questions, what area of life do you feel most needs your attention right now?

What specifically have you tried so far in the past that has helped to make changes? What Worked? What Didn't?

What would you like to see change in the next 3-6 months realistically?

Long What/who do you believe is holding you back from creating these changes?

What is the biggest fear, challenge or obstacle you believe about making this change/s?

What is your understanding of a holistic coach?

How do you think I may be able to help you in reaching this goal?

Is there anything you believe will hold you back from committing to meetings over our time together? Or anything else you want to share about yourself?

On a scale of 1 - 10... (10 being supremely ready, 0 being not ready) How READY are you to make changes in your life?

On a scale of 1 - 10... (10 being supremely willing, 0 being not willing at all) How WILLING are you to make changes in your life?

On a scale of 1 - 10... (10 being abundantly confident, 0 being not confident at all) How CONFIDENT are you to make changes in your life?

Do you have any current mental, physical, or emotional health concerns?

Do you require doctors clearance before any energy healing or breathwork sessions?

Are you taking any medications that I should know about?

Ready To Commit To Change? Sign below to confirm all the terms and conditions of this coaching contract, holding yourself accountable to move forward!

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Please select your preferred date and time for our first chat!

Day

Month

Year

Time

HoursMinutes