Simple Booking Request Form Url Congratulations beloved! We are honored you have chosen us to work alongside you as you take this much-needed step onto a new (or old) spiritual path. Our aim is to provide a basic roadmap, while holding space for you during this time in which we can watch you grow spiritually and evolve consciously, all while awakening to who you really are. Since we must follow the path of spirit too, please note that completion of this form does not guarantee a future working relationship. We will petition the spirit realm before contacting you and the initial client consultation may serve as a final confirmation to determine if we are an energetic fit. Nevertheless, we honor you whatever you are and we thank you, again, for your interest in working with us! Expect to hear from us within 3 to 5 business days (if not sooner). Peace and blessings, ~Jaketha - FIRST NAME: * - LAST NAME: * - GENDER: * - BIRTH DATE: * Used to calculate your energetic frequency / season - MOBILE NUMBER: * - SELFIE UPLOAD: Headshot, 2/3 or full-body; used for connecting with your energy - PRIMARY VIRTUAL SERVICE: * SPIRITUAL LIFE COACHING HOLISTIC HEALTH COACHING ON-DEMAND YOGA / MEDITATION Select the service that you are most in need of during these critical times. - (OPTIONAL) ADD-ON REMOTE SERVICE: DISTANT ENERGY HEALING: Reiki or Pranic Healing INTUITIVE READING: email, video, or text PRIVATE VIRTUAL YOGA / MEDITATION: 1-on-1 - PREFERRED VIRTUAL APPOINTMENT TIME: * No Preference Chi-Ball - Accept energetically when its convenient for you (i.e. energy healing) Weekday Morning 9-12 Weekday Afternoon 1-4 Weekday Evening 5-8 Weekend Morning 9-12 Weekend Afternoon 1-4 Weekend Evening 5-8 Structured, Self-Paced - complete assignments when its convenient - CURRENT TIME ZONE: Alaska Time Zone Central Time Zone Eastern Time Zone Hawaiian-Aleutian Time Zone Mountain Time Zone Pacific Time Zone Other Answer only if interested in live sessions. - PREFERRED VIRTUAL SESSION FREQUENCY: Weekly - a single session each week Bi-Weekly: two or more sessions in a single week Bi-Monthly: two or more sessions in a single month Monthly: one session per month Self-Paced/On-Demand Recordings No Preference - WHY ARE YOU IN NEED OF THE ABOVE SERVICES? Please refrain from sharing sensitive data. At a later date, you will be able to such details via a more secure platform. - WHAT DO YOU HOPE TO GAIN FROM WORKING WITH US? How does completing this service align with your personal goals and/or ambitions? - WHY ARE YOU INTERESTED IN WORKING WITH DPHEALER? Why are you drawn partnering with us? - INTERESTED IN JOINING OUR MAILING LIST? Yes No - I have thoroughly read and am in agreement with the Terms & Conditions, the Privacy Policy, and the Payments, Refunds & Returns Policy as posted on Jaketha.com. * Yes, I agree and accept.