Name
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First Name
Last Name
Email
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Birthday
MM
DD
YYYY
Birth Time
(Please provide birth time in the location of your birth despite the note below that says Hawaii time).
Hour
Minute
Second
AM
PM
Birth Place
What is your specific focus for our time together?
Share more context about why this is an important area of focus for you right now.
What are your most significant life stories or experiences that have defined / informed your sense of self?
What conditioned patterns, beliefs, behaviors are creating obstacles to what you truly want?
What do you want to believe / know / feel when this work is complete?
What do you really want to actualize in yourself and your life? What does your soul deeply desire?
How do you generally feel in your body? What's your relationship to your body like?
What grounding and centering practices or tools do you currently use in your life, if any?
What brings you alive, ignites joy, sparks interest, lights you up?
What are your personal superpowers?
Please describe any current or recurring emotional, spiritual or physical health challenges
Please specify or describe your spiritual or religious beliefs and influences.
What is your current occupation? What do you do? How long have you been doing it? Do you feel satisfied in your work? Why or why not.
If you are in a relationship, please describe the nature of the relationship and months or years together. If you are not in relationship, please share your current thoughts and desires about relationship.
On a scale of 1 - 10 (10 being maximum level) how stressed are you day to day? What is contributing to this current level of stress?
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How do you primarily respond to stress?
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Do you tend to move toward or against challenges? What about Desires?
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What happens when you get overwhelmed? Do you find yourself feeling overwhelmed a lot?
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How do you express anger? React toward anger? Feel about anger?
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Do you use drugs or alcohol? if so how do they influence you or affect your life?
Is there a history or mental illness in your family? If so, how has this imapcted you?
Do you have suicidal thoughts?
Yes
No
Have you ever attempted suicide?
Yes
No
Do you have thoughts or urges to harm others?
Yes
No
Have you ever been hospitalized for a psychiatric issue?
Yes
No
How you do usually react when things get stressful, confronting or difficult for you?
When and if this comes up during our time together, how would you most like to deal constructively with it?
Is there anything else you would like me to know before we begin?
What is your preference for sessions?
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In Person
Zoom
Phone
Declaration of Personal Sovereignty
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I accept full responsibility for my health - physical, mental, emotional, spiritual or otherwise. I acknowledge that by enrolling in any single session, series, or program with Tulasi, I am fully sovereign and in complete control of any and all life changing effects that may or may not occur. I understand that her recommendations are based on her somatic and psychological training, and intuitive perception, but in no way claim to cure or replace my own intuition or primary medical support. I understand that her work is meant to be a supplement to the care of my primary care provider and any other professional services I engage in. I understand that by agreeing to this work I am entering a holistic and synergistic container for my healing.
I have read the above and agree to accept full responsibility for my physical, mental, emotional, and spiritual health.
