Order Confirmation and Initial Session Call

WELcome to the quantum collective!

Below is a quick intake form and place for you to book your first session!

Be sure to do both before navigating away from this page!

First Name *

Last Name *

Email *

Phone *

I confirm that I want to receive content from this company using any contact information I provide.

Date of birth *

Location of Birth (if you don't know just put N/A) *

Time of Birth (if you don't know just put N/A) *

What is the main area of your life you feel stuck or struggle in? *

Ideally, how would you like your life to feel/look like? *

Do any of your concerns include physical pain, illness or disease? If so, please explain. *