CEREMONYQUESTIONNAIRE Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Food Allergies / Dietary Restrictions * Medications / Medical Conditions * Emergency Contact Name + Phone Number * Please list the parts of your physical body that cause you pain or discomfort. * When I say the word " Sexuality" how do you feel? * Describe in a few sentences the reality you see happening around you within the world. * Let's type it out : At the end of our time together, what do you desire to both manifest and embody within your experience? * When you close your eyes and meditate, what do you see within your minds eye that surrounds you? What do you envision that represents safety to you? * Please share below any other information you feel I should know or would like to share. * By typing your name below you understand that I (Britt Johnson) cannot guarantee results, nor responsible for specific desired outcomes. Your privacy is securely protected and your well-being both emotionally and physically are of the highest importance within this space. I (Britt Johnson) am not a medical professional and cannot cure or diagnose. You agree you've chosen to take this journey by your own freewill and were informed that you are always in control of your own mind and body. * Thank you!