Profile | Mare Simone

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Application for Consultation

I invite you to join me on a journey to juice up your life! This work is deep and personal so I like to know you intimately, enough to best support your needs and help you achieve your greatest goals! Please only fill out what you are comfortable sharing. Speak with you soon!

Name*
First
Name
Last (optional)
Gender*
- Male
- Female
Birthdate*
MM
DD
YYYY
Best Email Address*
Best Phone Number
Occupation*
Are you interested in:
- Private Sessions
- Workshops
Are you in a relationship?
- Yes
- No
If yes, is your partner open to take this journey with you? (If so, please have them fill out a separate form)
Briefly describe your relationship (or past relationships/patterns if you're single):
Desires and difficulties:*
What desires or challenges would you like to address?
On a scale of 1 - 10 how committed are you in resolving your issues?*
What is your desired outcome from our work together, within 3 and 6 months?*
Have you any background in personal development, spiritual practices; such as Tantra, Yoga or Martial Arts, dance etc?
How did you hear about me?
What country, city, state and zip code do you live in?*
Also include other locations where you'd like to meet.
Comments / Questions
Name
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Apply Here:

Application for Consultation