Sacred Space Weaver Intake FormOnline Training Name * First Name Last Name Email * Address * Date of Birth * Gender * If you are female, are you currently pregnant, or is there a possibility that you will be pregnant by the time you take this course? * Yes No Not Applicable Partnership Status * Occupation Why do you want to take this course? * Previous Training * Please list any modalities you are trained in and any previous relevant shamanic or ceremony training. Please outline what skills you have working with clients. * Why do you feel your skills and experience prepare you for this work? * In past workshops or trainings you have attended, what have been the main problems? * What have been the greatest difficulties in your life? * Please provide a paragraph outlining your personal philosophy of life and how you see yourself using this training in the future. Spiritual Beliefs - Do you believe in a soul, higher self, or a creator? Please indicate if you follow a particular religious or spiritual practice, or describe your cosmology and how you view creation. Please indicate your response to the following statements by rating them according to this scale: Strongly disagree = 1 or 10 = Strongly agree When Things go wrong, it is usually because people are not considerate of others? 1 2 3 4 5 6 7 8 9 10 I hate some people for the way they act. 1 2 3 4 5 6 7 8 9 10 People are not out to take care of themselves first 1 2 3 4 5 6 7 8 9 10 One of my obligations is to improve the behaviour of others. 1 2 3 4 5 6 7 8 9 10 Life has treated me fairly 1 2 3 4 5 6 7 8 9 10 Perceptual Modalities - Please Indicate your dominant senses * You can select more than one Visual Auditory Kinesthetic Olfactory Gustatory Self Development: Please indicate if you have done any of the following: None Shadow Work Inner Child Work Self Love Practices Ancestral Healing Other Please indicate how you think you will pay? AU$500 Deposit, then AU$1000 by 11th March 2026, then remaining before 8th of April 2026 I wish to work out a payment plan for this Are you presently seeing, or have you ever been under the treatment of a psychiatrist, psychologist or doctor? * Yes No Any Mental Illness diagnosis, hospitalisation or episodes? * Check all that apply None Mental Illness Diagnosis Hospitalisation due to Mental Illness Psychotic Episodes Psychosis Psychiatric Disorders Bipolar ADHD Other Emotional or Anxiety Issues * Check all that apply to you None Anxiety Stress Depression Anger Issues Grief Bereavement Changes in Situation Other Emotional Issues List any Fears or Phobias * Do you have any medical conditions or psychological history that we should be aware of? * What do you think of this Questionnaire? * Thank you!
