How to use this form:

Please copy and paste this questionnaire into an email, answer as many questions as you comfortably can, and email me your responses prior to the healing session. This will ensure the session runs smoothly and efficiently for the greatest healing to occur. Please know that the information can be very useful.

Note: All information will be kept strictly confidential.


  • Full name:
  • Contact number:
  • Email address:
  • Preferred method of communication:
  • Address:
  • Age:
  • Date of birth:
  • Location of birth:
  • Time of birth:
  • Zodiac sign:


  • Body pains? When did they start? What was happening in your life when they started?

  • Have any tooth fillings? If so, how many?

  • Smoke cigarettes now, or ever?

  • On any medication?

  • Have you ever done any drugs?

  • Have any birth marks? If so, where?

  • Are you vegetarian or vegan?

  • Do you have any allergies or food intolerances?

  • Done colonic hydrotherapy?

  • Done a liver and gallbladder or kidney cleanse? If so, how many?

  • Done crystal healing?

  • Done energy healing (e.g. Reiki)?

  • Done reflexology?

  • Done sound healing?

  • Done ear candling?

  • Have you had your kundalini raised?

  • Have you done an ascension session?

  • Know how to bring light / energy into your body through your crown chakra? (Your eyes often flash when doing this).

  • Have any tattoos, if so why did you get them?

  • Have any piercings?

  • Carry any crystals? If so, please detail type, size and quantity.

  • Wear crystal power bracelets?

  • Do yoga?

  • Do regular walking or other forms of exercise?

  • Get out in nature regularly? How often?

  • When was the last time you wept? Do you cry often?

  • Can you see or feel other people’s energies?

  • Use earphones or hands-free when on the phone?

Mind and emotions:

  • Do you dream often? Are there any significant dreams that stand out, please describe?

  • Do you keep a dream diary?

  • Have any phobias?

  • Are you psychic, intuitive, sensitive?

  • Can you see or feel other people’s energies?

  • Ever had a psychic reading? If so, how many?

  • Meditate? How often? For how long?

  • Have you connected with your higher-self and or spirit guides? If so, who are they?

  • Do you pray? How often?

  • Do you follow any religion?

  • Are you spiritual?

  • Are you generally happy?

  • Do affirmations?

  • Use thought amplifiers – crystals – when doing affirmations?

  • Have you read ‘Ask and it is Given’ by Abraham and Esther and Jerry Hicks? Or know about Law of Attraction?

  • Have you taken any spiritual workshops or attended spiritual conferences? Which ones?

  • What is your willingness to learn from 0-10 (10 being the highest)?

  • What is your willingness to change from 0-10 (10 being the highest)?

  • What is your willingness to do things on faith from 0-10 (10 being the highest)?

  • Are you willing to allow (not resist) your healing?


  • Please list all appropriate or significant relationships – person’s name and connection (spouse, sibling, parent, child, friend, etc.)

  • List any significant problems or issues I need to know about in your home life.

  • Do you believe you have a soulmate or partner in life, that you will one day meet?

  • Believe in destiny?


  • Occupation?

  • Do you truly enjoy your work?


  • Comfortable talking about money?

  • Have any debts, if so, what type?

  • Can you afford my fee?

  • Are you happy to pay the full fee up-front?


  • Why do you want to do QHHT?

  • Do you know how QHHT works?

  • Do you have any questions or issues with hypnosis?

  • Do you drive?

  • Have you had any type of accidents?

  • Had any spiritual experiences?

  • Been to any sacred sites e.g. Glastonbury Tor, the Great Pyramid of Giza, Maccu Piccu, Stonehenge, etc.

  • Done an astrological reading or personal chart?

  • Seen a palmist and had your palm read?

  • Familiar with the term ‘soul contracts’? Know what they are?

  • Aware you may have taken vows in current or lives, which may be effecting you in this life?

  • Do you know what your life plan or purpose is?

  • Are you familiar with the Archangels?

  • Have a mentor?

  • Ever been to the College of Psychic Studies?

  • What’s your chosen wording for: Source, God, the Creator?

  • Why me (as your chosen healer)?


Published by maximizedperspectives

I am full of love, light and happiness.


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