Application to work with me

Hello beloved sister!

I’m so pleased to hear that you would like to work with me either in a 1-1 capacity or attend a group temple/circle experience.

Please answer the following questions and submit your application. Once submitted, please allow 48 hours for a response.

With love
Jacquie

* Indicates required field

How did you hear about my circle/temple experiences? *

Internet Search Advertisement Friend - please specify who Other - please specify

Specify here *

Name *

First

Last

Email *

Phone Number *

Please advise a Next of Kin Emergency Contact *

What service are you interested in? *

1-1 Services Group Experiences

What is calling you to be part of a temple/ circle experience? *

Do you have a practice to still your mind? If so, please explain. *

Have you worked with archetypal or alchemical energy before? If so, in what context? *

Have you been in therapy in the past or presently? If so, when and in what form? (That is: What work are you presently doing or what have you done to heal the emotional woundings of your passage through life?) Please be specific as to the type and length of work. *

Are you in recovery from drugs, alcohol, or any other addiction? If yes, for how long and what kind of recovery have you engaged in? *

Do you have any physical ailments or restrictions that would prevent you from sitting in ritual circle for a few hours at a time? *

In the past five years (or currently) have you been prescribed any psychiatric medications? If so, please list which one(s) and for what they were prescribed. *

Place your hand on your heart, turn to the wise inner self and ask, are you ready for your next step of growth and change? *

Is there anything else that you feel is important to share? *

Thank you beloved.

Warm wishes
Jacquie

I agree to receiving marketing and promotional materials *

Submit