If you would like to booking an appointment, please complete the form below to send your enquiry. Name * First Name Last Name Email * Please describe your intention that you would like work with. * Do you have any health issues? If yes, please describe: * How do you treat your body? How is your diet and level of physical activity? Please describe * Do you suffer from any of the following health issues? * High or low blood, please describe Diabetes Cardiac problems Epilepsy Dizziness or unexplained fainting Are you pregnant? Is yes, how many months. * Do you have any allergies? If yes, please specify: * Have you ever used any psychiatric medication or antidepressants? If yes, please describe (when and which medication): * How do you feel about yourself? Do you love who you are? Yes or no, could you please explain a little bit: * What is spirituality for you? * Do you have any daily practices? If yes, what are they? * Is there anything you would like to improve or develop about yourself? * I confirm that all of the answers above are true and I am responsible for each of them. * Yes, I agree No, I disagree Date * MM DD YYYY Sign Up your full name * Thank you! Contactrudrani1304@gmail.com Follow
