one-on-one intake form

Client Information

Thank you for filling out our one on one session intake form.
Your information is completely confidential and only used to support you during our session.

SET ASIDE SOME QUIET TIME FOR YOURSELF TO MEDITATE AND ANSWER A FEW QUESTIONS BELOW THAT WILL ASSIST YOU IN EXPLORING YOUR INTENTIONS AT YOUR SESSION. PLEASE GIVE IT YOUR FULL 100% ATTENTION AND ANSWER THE FOLLOWING QUESTIONS WITH AS MUCH DEPTH AS POSSIBLE.

ARE YOU READY FOR TRANSFORMATION? YOU WILL RECEIVE WHAT YOU PUT IN. PLAY FULL OUT!

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One-On-One Session

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you find out about Esther Jenkins? *

Age *

Birthday *

Birthplace *

If you answered yes to children, what are their Ages and Gender? *

Occupation *

Religious Preference *

What moved you to sign up for a Session with Esther Jenkins? *

What are your specific intentions for your Session? *

What are your unique gifts and what do you feel is your purpose in life? *

List all questions you would like Esther to address for you during the Session. Be specific. *

Health Questions

Have you previously experienced energy, Shamanic healing or any other therapeutic healing modality? *

Name of Present physician and/or health practitioner or Therapist *

Do you have any physical disorders, or health problems? Or history of them? *

Please list all previous major Illnesses, surgeries, hospitalizations and injuries and the year of occurrence. *

Are there any residual effects? *

Do you exercise regularly? If so, what form? How often? *

Do you smoke, drink or use any other form of mind altering substance? If so what, and how often? *

Are you currently on any form of medication, vitamins? If so, what type? *

PLEASE GIVE A DETAILED HISTORY OF YOUR RELATIONSHIPS WITH YOUR FAMILY, FOR EXAMPLE YOUR PARENTS, SIBLINGS, EXTENDED FAMILY, ETC. *

Is there anything else that you think I need to know, or that you would like to share? *

Submit

What Students and Clients are saying:

"I have experiencing huge growth and transformation while walking this path and with Esther Jenkins. I love that she shares her wisdom, experience, and breadth of knowledge generously and with humility. Love her !!! ♥."

“I have been transformed by Esther’s teachings. Not only have I learned to identify inner blockages but I have been given the tools necessary to work with the inner child in order to prevent self-sabotage.”

"Thank you for taking a neophyte under your wing and teaching her so much. I knew so little about so many things, and you set me on a journey to reach new heights and places I never knew existed. Still, I have so much more to learn."

Read what previous students in the Level 1 Program shared about their experience:

"Months prior to taking this class, I saw Judeann in a dream as my teacher. Out of fear of stepping outside of my comfort zone, I hesitated to join her class, but with some time, I finally came around to the idea. One of the best decisions of my life. Within just 4 weeks, I experienced some of the deepest transformation and spiritual growth, and took away many lessons that I will be able to share with the community around me as well. I am so grateful for this class, and the beautiful connections that came from it. A’ho!"

"This class showed up for me at the perfect timing. I said yes to my soul’s calling to return to nature and learn how to heal through understanding our own energy power. Not only can I support in healing myself and my family, this will help my community in living a more fulfilled life. This class will teach you how to change your physical manifestations by working with your spiritual self. It is a must take! "🙏🏽

"I was excited to take the class coming out of COVID as there was so much darkness and heaviness weighing on my Spirit from the year. Not only did the class help alleviate lots of suffering that I was holding on to, but it gave me tangible ways to transmute my energy for future upsets. The practice is beautifully connected to nature and coming out of the class I feel reminded of the relationship between myself and all the world’s naturalistic/cosmic energies in vast new way. I highly recommend this class for anyone who is looking to gain self care practices for their spirituality and themselves. I’m proud to be a mesa carrier."

"I would like to give a big shout out to Judeann and Suzette for taking me, as well as the other students, under their guidance and helping me improve myself. In our life we carry heavy and light energy and I learned how to diffuse and also heal old wounds that I didnt think I could ever overcome on my own. I am looking forward to my next journey in September!"

Contact Us

Phone Number:

(626) 224-8830

Email:

esthershaman@earthlink.net

Location:

Glendora, CA 91741

Private Session Intake

Client Information

One-On-One Session

Health Questions

What Students and Clients are saying:

Contact Us

Phone Number:

Email:

Location:

Subscribe to find out about upcoming
workshops & lectures!

Private Session Intake

Client Information

​One-On-One Session

Health Questions

What Students and Clients are saying:

Contact Us

Phone Number:

Email:

Location:

Subscribe to find out about upcoming workshops & lectures!

One-On-One Session

Subscribe to find out about upcoming
workshops & lectures!