In-Person Session Form

Please fill out this form to book your session.

Full Name *

Age *

Your Location (city, state, country) *

Best contact number: *

Best email *

Occupation/Self Employeed *

Children / Ages / Pets *

Type of Session

• 60 Minute Paid In-Person Session
• 90 Minute Paid In-Person Session
• Trade

What address would you like Kenji to visit if this is an at-home visit (optional)

Current Spiritual Focus/Highest Spiritual Aspirations *

Your current level of stress:

• 1 - Very low
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 - Very High

Custom Activation: How may we assist you with your healing and transformation? *

What is your life purpose and goal? *

What is your greatest life challenge and fear? *

List any traumas / injuries / money issues that have not healed *

Are You Empathic/Over Sensitive/Channeler/Telepath? *

Do You Meditation and/or Pray? *

Is this a paid session?

• Yes
• No

Referred by *

Phone

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