What is currently not working the way you know it could?
Not in theory. In your actual results, decisions, or energy.
Please share your Phone Number:
What is your age?
When where you born, which date, and what time?
Where do you currently live?
Name your City & Country
Your Current Reality
What is/was your profession or role?
How long have you been in this position or business?
If entrepreneur: from the moment you earned consistent income.
Emotional Check-in
Which emotional patterns currently play a role in your life?
(Select all that apply)
Healing & Patterns
What have you done previously to heal your relationship with love, money, and self-worth?
List anything that comes to mind - coaching, therapy, retreats, breathwork, etc.
What layer is still missing today?
What feels unresolved or recently opened up in you?
Did you grow up in an emotionally unstable, controlling, or inconsistent environment?
Relationships & Truth
What’s been your longest love relationship? And your most meaningful friendship/business connection?
Share duration + emotional imprint.
What’s the pattern you see across your relationships - both light and shadow?
Inner Vision
What would financial freedom look and feel like to you?
Practical and energetic vision welcome.
What is freedom for you - and how do you imagine your lifestyle being funded?
When did you set the intention to be financially free?
Choose a date - or declare one now.
When did you set the intention to be in a loving, committed relationship?
If you’re already in one, how long? If not, pick your moment.
Challenges & Needs
What are the 3 biggest blocks keeping you from:
a) Finding your true love
b) Creating financial freedom
Let it be honest - and not strategic.
If I could help you in 3 areas, where would you most want support?
Resonance Check
On a scale from 1 to 10 - how committed are you to becoming a true match for your wealth?
(1 = not at all — 10 = Absolutely ready. Below 8 is not a fit for this container.)
Are you ready to invest for the Retreat or by invitation for The Worthy Empress:
Final Words
Did someone referred you?
If yes, put their name here…
Is there anything else that feels important for me to know right now?
Something personal, energetic, ancestral - or simply true.
