Chakaura by Michele

Discover Consulting Call with Chakaura Specialist

Please fill out the below information to better understand your needs and how we can help you during your call.

Consulting Call Form

Responses are private and confidential. Chakaura adheres to high codes of ethics and privacy and only under law or if a person was life threatened would we share private information to the proper authority.

Name(Required)
Address(Required)
Please be sure to include country code or area codes if outside Canada or Mexico.
If you are under 18 years of age, you will require parental/guardian consent.
MM slash DD slash YYYY
What is your sex at birth?(Required)
What is your marital status?(Required)
Timeline for an Appointment with one of our Chakauraâ„¢ Specialist(Required)
Please type N/A if not applicable.
Are you presently being followed by a medical professional?(Required)
Physical Health, Mental or Emotional Support, Spiritual Related, or Other, please specify.
What is the main area of services you wish support with?(Required)
Are you presently following or practicing any self-help modalities such as energy work therapy such as Reiki, therapeutic touch, meditation groups, esoteric practices such as Yoga of any type, consulting a psychic medium, a psychiatrist, a psychologist, following a spiritual teacher or master, part of a ashram or other?(Required)
Type N/A if not applicable.
Are you taking any prescription drugs? (Only if you are comfortable sharing)
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