Your Name *

First Name

Last Name

Name of Remote Work Recipient (if not Self)

First Name

Last Name

Age (of person receiving the remote work) *

Younger than 21 years old

21-35 years old

36-50 years old

50-70 years old

70+ years old

What area of life would you like the remote work to address? *

Please choose only one.

Money & Career

Romantic Love

Health (Physical or Mental)

Spiritual Development

Family

Friendships/Community

Have any of the following events occurred in the last 6 months (for the person receiving the remote work?) *

Please choose all that apply.

Death of a Relative

Physical Health Diagnosis

Mental Health Diagnosis

Relocation

New Job or Business Opportunity

Caretaking for a Sick or Unwell Individual

Change in Emotional Baseline

Job Termination or Housing Eviction

Pregnancy (Regardless if Carried to Full Term)

Change in Sleep

Significant Weight Gain or Weight Loss

None

I don't know.

Spiritual Practices (of the person receiving the remote work) *

Please choose all that apply for the last 6 months.

Traditional Religion (mass, church/mosque/synagogue/etc.)

Non-Traditional Christian Sects (e.g., Jehovah's Witness, Mormonism, 7th Day Adventist, etc.)

Meditation

Yoga

Psychedelics, mushrooms, etc. used for spiritual purposes

Shamanic practices (e.g., drumming, trance, Ayahuasca, etc.)

Ancestral Worship

Hypnotherapy

Reiki or Energy Work

Fasting

Other

None

I don't know.