Name *

First Name

Last Name

Phone

(###)

###

####

Do you come from a religious background? *

Religious: of or belonging to an organized system of faith + worship.

Yes

No

In present time, do you still identify as a religious person? *

Yes

No

If yes, do you engage with religions outside of the one you belong to?

Yes

No

In present time, do you consider yourself a spiritual person? *

Spiritual: connected to a higher power and / or unseen forces to navigate life & reality, not necessarily from a religious context.

Yes

No

The Earth is an important component + collaborator in my spiritual practice. *

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Is ceremony part of your spiritual practice? *

Ceremony: a container of time + space to spiritually mark or commemorate an ending or beginning.

Yes

No

If no, do you want it to be?

Yes

No

Preferred Day(s) for follow-up Orientation Call: *

Tuesday

Wednesday

Thursday

Friday

Saturday

Preferred Time(s) for follow-up Orientation Call: *

Morning

Afternoon

Evening (virtual only)