Client Intake Form: March Equinox Retreat

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* 1. Name:

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* 2. Email Address:

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* 3. Current Occupation:

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* 4. Do you what your higher purpose is? If so, what is it?

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* 5. Complete the following questions with regards to the codes found within YOUR BIRTH NAME in your Hebrew Soul Purpose Profile (The Star of David). You can download your profile and eBook here. Coupon code is: DNACalculator

	Strongly agree	Agree	Uncertain	Disagree	Strongly disagree
5.1 I have fully embodied by My Physical Talents and I can visibly see results of these in my physical reality	5.1 I have fully embodied by My Physical Talents and I can visibly see results of these in my physical reality Strongly agree	5.1 I have fully embodied by My Physical Talents and I can visibly see results of these in my physical reality Agree	5.1 I have fully embodied by My Physical Talents and I can visibly see results of these in my physical reality Uncertain	5.1 I have fully embodied by My Physical Talents and I can visibly see results of these in my physical reality Disagree	5.1 I have fully embodied by My Physical Talents and I can visibly see results of these in my physical reality Strongly disagree
5.2 I have fully embodied by My spiritual Talents and I can visibly see results of these in my physical reality	5.2 I have fully embodied by My spiritual Talents and I can visibly see results of these in my physical reality Strongly agree	5.2 I have fully embodied by My spiritual Talents and I can visibly see results of these in my physical reality Agree	5.2 I have fully embodied by My spiritual Talents and I can visibly see results of these in my physical reality Uncertain	5.2 I have fully embodied by My spiritual Talents and I can visibly see results of these in my physical reality Disagree	5.2 I have fully embodied by My spiritual Talents and I can visibly see results of these in my physical reality Strongly disagree
5.3 My Physical Challenges have been fully transmuted into talents	5.3 My Physical Challenges have been fully transmuted into talents Strongly agree	5.3 My Physical Challenges have been fully transmuted into talents Agree	5.3 My Physical Challenges have been fully transmuted into talents Uncertain	5.3 My Physical Challenges have been fully transmuted into talents Disagree	5.3 My Physical Challenges have been fully transmuted into talents Strongly disagree
5.4 My Spiritual Challenges have been fully transmuted into talents	5.4 My Spiritual Challenges have been fully transmuted into talents Strongly agree	5.4 My Spiritual Challenges have been fully transmuted into talents Agree	5.4 My Spiritual Challenges have been fully transmuted into talents Uncertain	5.4 My Spiritual Challenges have been fully transmuted into talents Disagree	5.4 My Spiritual Challenges have been fully transmuted into talents Strongly disagree
5.5 I have achieved my physical goals and I can see the results in my physical reality	5.5 I have achieved my physical goals and I can see the results in my physical reality Strongly agree	5.5 I have achieved my physical goals and I can see the results in my physical reality Agree	5.5 I have achieved my physical goals and I can see the results in my physical reality Uncertain	5.5 I have achieved my physical goals and I can see the results in my physical reality Disagree	5.5 I have achieved my physical goals and I can see the results in my physical reality Strongly disagree
5.6 I have (or am in the process of) achieving my spiritual goals and can see results in my physical activity	5.6 I have (or am in the process of) achieving my spiritual goals and can see results in my physical activity Strongly agree	5.6 I have (or am in the process of) achieving my spiritual goals and can see results in my physical activity Agree	5.6 I have (or am in the process of) achieving my spiritual goals and can see results in my physical activity Uncertain	5.6 I have (or am in the process of) achieving my spiritual goals and can see results in my physical activity Disagree	5.6 I have (or am in the process of) achieving my spiritual goals and can see results in my physical activity Strongly disagree
5.7 I have psychically embodied by soul destiny and can see results in my physical reality	5.7 I have psychically embodied by soul destiny and can see results in my physical reality Strongly agree	5.7 I have psychically embodied by soul destiny and can see results in my physical reality Agree	5.7 I have psychically embodied by soul destiny and can see results in my physical reality Uncertain	5.7 I have psychically embodied by soul destiny and can see results in my physical reality Disagree	5.7 I have psychically embodied by soul destiny and can see results in my physical reality Strongly disagree

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* 6. In the same way as above, please complete the following:

	Strongly agree	Agree	Uncertain	Disagree	Strongly disagree
6.1 I already know how to manage and protect my energy	6.1 I already know how to manage and protect my energy Strongly agree	6.1 I already know how to manage and protect my energy Agree	6.1 I already know how to manage and protect my energy Uncertain	6.1 I already know how to manage and protect my energy Disagree	6.1 I already know how to manage and protect my energy Strongly disagree
6.2 I feel spiritually aligned with my purpose in my career	6.2 I feel spiritually aligned with my purpose in my career Strongly agree	6.2 I feel spiritually aligned with my purpose in my career Agree	6.2 I feel spiritually aligned with my purpose in my career Uncertain	6.2 I feel spiritually aligned with my purpose in my career Disagree	6.2 I feel spiritually aligned with my purpose in my career Strongly disagree
6.3 I’m being suitably remunerated for my purpose based career	6.3 I’m being suitably remunerated for my purpose based career Strongly agree	6.3 I’m being suitably remunerated for my purpose based career Agree	6.3 I’m being suitably remunerated for my purpose based career Uncertain	6.3 I’m being suitably remunerated for my purpose based career Disagree	6.3 I’m being suitably remunerated for my purpose based career Strongly disagree
6.4 I understand what my mission is about	6.4 I understand what my mission is about Strongly agree	6.4 I understand what my mission is about Agree	6.4 I understand what my mission is about Uncertain	6.4 I understand what my mission is about Disagree	6.4 I understand what my mission is about Strongly disagree

Thank you for completing this evaluation form for the March Equinox Retreat in Sedona. I look forward to supporting you in your sacred rite of passage home to your true self!

Ariella x