Private Session - Weight Release Questionnaire

Please complete the form below, so that Krystalya can prepare for your upcoming session. The questionnaire is quite lengthy, so that Krystalya has as much information as possible about you and your situation as possible. That way she can focus more on actions and results during your time together.

If something is not applicable to you, please feel free to put N/A in the field.  You will need to complete the entire questionnaire in one sitting.

Once the form is completed you will be redirected to Krystalya’s calendar, where you can select the best day and time for your session. Feel free to contact us through the Contact form (see menu above) if you have any questions.

Private Session for Weight Release

Full Name *

Email Address *

Phone Number

Skype ID

Please provide your Skype ID - if you would prefer that we do your Session on Skype

Which way do you prefer to connect for our call?

US Based Conference Line

Skype

Remote Session (at specified time Krystalya works remotely without direct contact on phone) note this session must be for you personally or you must be the guardian for the person Krystalya is working on.

Describe in as much detail as possible what you desire to achieve during this session.

Describe in detail your commitment to achieving your desired results

What is Your Strongest Sense? Select One of the Senses in the List BelowTactile (Kinesthetic)VisualSoundSmellTaste

What is Your 2nd Strongest Sense? Select One of the Senses in the List BelowTactile (Kinesthetic)VisualSoundSmellTaste

What is Your 3rd Strongest Sense? Select One of the Senses in the List BelowTactile (Kinesthetic)VisualSoundSmellTaste

What is Your 4th Strongest Sense? Select One of the Senses in the List BelowTactile (Kinesthetic)VisualSoundSmellTaste

What is Your Weakest Sense? Select One of the Senses in the List BelowTactile (Kinesthetic)VisualSoundSmellTaste

How long do you believe it takes to change a belief?

Have you completed the instantly changing your beliefs process?

Yes

No

Do you believe it is necessary to visit individual events in your life in order to heal that aspect of your life affected by the event?

Yes

No

Please describe in detail your beliefs around the need to visit individual events in your life in order to heal the aspect of your life affected by the event.

What is your greatest fear?

Do you meditate?

Yes

No

If you answered Yes, how frequently do you meditate? How long do you typically meditate?

Do You Currently Journal

Yes

No

If you answered yes, how frequently do you journal? How much time do you spend journaling each time? Approximately how many pages do you write in your journal during a typical journaling session?

Are you open to delving into any of the following to determine what may be keeping you from achieving the weight you desire? Please select all that you are open to explore.

Blocked Energy Centers / Chakras

Self-Love

Thoughts / Mind Chatter / What are you Telling Yourself

Beliefs

Fears

Clinging to the Past

Clinging to the Future

Anger

Forgiveness

Guilt

Abandonment

Beliefs About Hereditary Causes

Blame

Describe your belief about karma.

Do you currently do affirmations on a regular basis?

Yes

No

If you answered yes, how frequently do you do your affirmations?

If you answered yes, please describe how you do your affirmations (i.e. in a mirror, out loud, silently, etc.)

If you answered yes, please share some of the affirmations you are currently using.

Do you believe you have the power to create miracles in your life?

Yes

No

Please describe your belief about creating miracles in you life.

Describe in detail what you have done or are doing to achieve your weight loss goal.

Describe how well what you have done or are currently doing has/is working for you.

Do you believe you are responsible for everything in your life or do you blame others or circumstances? Please describe in detail your thoughts on this.

Do you have an exercise / workout program or routine that you follow?

Yes

No

If you answered yes, how frequently do you exercise/workout? How long is each typical session?

If you answered yes, please describe your workout/exercise program in detail.

What is your current weight?

How much weight do you want to release?

Describe yourself in regards to how you see yourself at your current weight.

Describe yourself in regards to how you see yourself once you achieve your weight release goal.

Are you under a Doctor's care for your weight?

Yes

No

If you answered yes, how long have you been under a Doctor's care for your weight?

Describe any predictions your Doctor has made regarding your weight.

If your Doctor has made any predictions, please describe your feelings/attitude with regards to those predictions.

Describe your current diet (what you eat, what you drink, how often, etc.)

What are you beliefs about your weight?

Do you believe your weight issue is a hereditary health issue?

Yes

No

If yes, who has had the problem, what is their relationship to you and how do you see their excess weight affecting them?

Describe your beliefs about weight release programs and diets, include what you think works and doesn't work.

Describe how you feel about exercise.

Are you willing to include exercise in your weight release program?

How long do you believe it will take to achieve your ideal weight?

Do you believe that weight problems only have a physical component? Please describe your beliefs about this.

What is your belief about there being an emotional component to your weight problems?

Where on your body are you carrying the most extra weight?

Do you have any specific foods that you crave more than others, please list below.

What is your biggest fear about attaining your ideal weight?

Do you have friends or family to support you in achieving your weight goal?

Yes

No

If yes, please list and describe the type of support you believe they can and will give you.

Link to Session Symbols

Recording Link

If you are human, leave this field blank.

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Disclaimer:
The information provided on this site is designed to provide information regarding the author’s experience utilizing the included symbols to shift energy within her body for the purposes of healing herself. Information provided also includes the experiences of others who have utilized this work. This work is not intended to be used for the purposes of diagnosing or curing/healing any ailment and is experimental in nature. The work is also not intended to take the place of any medical doctor’s advice or treatment. The author does not dispense medical advice; nor does she prescribe the use of any technique as a form of treatment for medical problems without the advice of a physician, either directly or indirectly. The intention in providing the information included in this newsletter is only to offer information of a general nature to help you cooperate with your licensed doctor/medical practitioner in your quest for health. In the event that you use any of the information in this newsletter, you are responsible for prescribing for yourself, which is your constitutional right, but the author assumes no responsibility for your actions.

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