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Full Name*

City*

Mobile Number*

What is the challenge/issue you are facing ?*

Business career

Relationship

Health

Wealth (Money)

Spirituality (SELF KNOWING, EMOTIONS, QUALITIES ,DOUBT)

Do you feel continuous stress? *

Yes

No

Write Something about your feeling*

Do you have any painful memory?*

Yes

No

If YES Write something about your painful memory in detail *

Do You have any unfulfilled wish or regret? *

Yes

No

If YES Write something about it*

Do you able to see your future?*

Blank Darkness

Something Unclear

Absolute Clear

Write something about your future what you feel when you close your eyes*

Do you have any fear or phobia ?*

Yes

No

If YES Write something about it *

In which area Write something about it .*

Do you listen to some unwanted internal dialog?*

Yes

No

If YES Write something about it*

How was your relation with parents & sibling?*

Good

Best

Worst

Write something about it*

Have you lost someone in life?*

Yes

No

If YES Write something about it*

How was your childhood?*

Happy & Fantasy

Sacrifices, Guilty & unhappy

Write something about it*

Have you feel cheated in life?*

Yes

No

If YES Write something about it*

Do you being harsh or abuse by somebody ?*

Yes

No

If YES by whom in past or in present*

Do you feel revenge for someone?*

Yes

No

If YES to whom *

Do you feel Life have not played well with you?*

Yes

No

If YES Write something about it*

When do you sleep or wake up? Write Sleep & Wake Up time*

Are you able to sleep properly?*

Yes

No

Face difficulty to fall asleep

Write something about it*

Do you feel challenges are bigger than you?*

Yes

No

If YES Why*

What are you hobbies? Write something about it

What are the benefits if you get rid of issues? Write something about it

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