Past Life Regression
Intake Form

To begin your Past Life Regression Therapy journey, please download the Past Life Regression Intake Form using our link button. Or, you can use our online PLRT form below . Once completed, kindly hit submit or return the form by email to light-manor@outlook.com. After we’ve reviewed your information and personal story, we’ll be in touch to schedule your Intake Meeting. This helps us prepare for your session and ensure a safe, supportive experience tailored to your unique path.

Past Life Regression Intake Form

This intake is important and will be closely read. A well completed form is required to be appropriate to receive hypnotherapy sessions. The more you put into the process, the more you get out of it.

First name

Last name

Phone Number

1) Can you enter into a hypnotic state? Have you practiced self hypnosis? Do you have any questions about what hypnosis is?

2) Have you experienced hypnosis or hypnotherapy sessions? How many? For what purpose? What was the outcome?

3) Have you experienced formal Past Life Regression sessions? How many? For what purpose? What was the outcome?

4) Have you had spontaneous Past Life recall? Describe

5) Are you a healer? In what modalities?

6) Have you met or do you know your Spirit Guides? Describe

7) What Present Life issue do you want to focus on with PLRT? What is your compelling need for a session? What issue are you now facing that is causing significant pain and requires a therapeutic resolution?

8) What are your feelings, thoughts and questions about your issue?

9) How does the issue affect you? Describe a specific moment in the last few weeks to illustrate, including what you saw, heard and felt.

10) How long has this been an issue? Has it changed over time?

11) Who are the Key People involved in your present life issues? Describe your relationship with them in this life, and the current state of relationship.

12) What information or theory do you already have about the cause and nature of your issue?

13) What outcomes would you like to get after the sessions?

14) Do you have a question you would like to have answered?

Do you have a headset with built in microphone? A camara that captures your face, upper body, with good light? Do you have a solid device and Wi-fi that is stable for 90 plus minutes? These are all required.

Can you attend three to five personal sessions, once a week for three to five weeks?

Do you require Donation Based Sessions? Why?*

Yes, subscribe me to your free Monthly Monk and Student Story and Free MP3 Guided Meditation.

Do you accept and agree with our RELEASE, WAIVER OF LIABILITY, AND BOOKING POLICY AGREEMENT*

Yes

Signature

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