Name
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
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              Place of Residence
              
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              Occupation
              
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              What main limitations, obstacles, or edges are you currently experiencing in your life and/or relationships?
              
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              What three shifts are you most yearning to create in your life and/or relationships as a result of your work with Nina? How do you envision yourself in one year from now?
              
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              Please list any trainings, programs, or courses you have attended in the realms of personal growth, spirituality, feminine embodiment, and/or sacred intimacy.
              
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              Do you have a regular spiritual practice such as meditation, prayer, yoga, dance, etc.? If yes, please describe.
              
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              Have you in the past two years been under the care of a therapist or mental health professional? Have you ever experienced any traumatic or emotional conditions that are relevant to this program, including childhood emotional or physical abuse? If yes, please describe.
              
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              I am interested in...
              
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              Are you interested in adding on ongoing text & voice note support?
              
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              How did you learn about Nina?
              
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              Is there anything else that may be important to know about you?