Private Consultation In-Take Form

Name*
First Last
Age*
Location*
Email*
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Date*
MM slash DD slash YYYY
Please summarize the most recent meditation technique you have been using and what your overall progress has been.*
Describe your current emotional processing methods, any advancements you have made in this area, and any roadblocks you are experiencing.*
Previous One-on-One Work
Have you done one-on-one work with Lucia in a Private Consultation?*
- NO
- YES
If you answered "yes", when was your last Private Consultation?*
What issues did you tackle after your last Private Consultation with Lucia and what has your overall progress been?*

Previous One-on-One Work