Please fill in the questions below at least 3 days prior to your regression. Your information is confidential and won’t be shared anywhere else.

First + Last Name

Date of Birth

Where were you born?

City & Country

Where do you live now?

City & Country

Your occupation

What takes up the majority of your time?

Your list of up to 12 questions you'd like to ask your Higher Self. There’s no need to provide detailed explanations for your questions, as we will go over them together on the day of your Past Life Regression.

If you’d prefer, you can email your questions in advance to hello@marije.co. Please make sure to send them a few days before our session.

How is your physical health?

Please list physical symptoms (if you have any) here:

Are you on any medication?

Yes

Who are the most important people in your life now?

Please note their name and who they are to you.

Who have been important people in your life when you were younger?

Anyone who was not mentioned on your list above.

Have you done a past life regression before?

Yes

If you've have done a regression before, please describe what you experienced here:

If you haven't done a regression before, please skip this question

Why is now the right time in your life to experience a past life regression?

Are you familiar with Dolores Cannon's work?

Yes

How would you grade your life right now?

On a scale of 1 till 10. 10 being the highest.

Other important info