Harmonic Reading: Client Intake Form

A Mirror of Your Soul’s Geometry

Welcome.
This reading is not a prediction. It is a remembrance.
Please answer the following with clarity and care. Your responses allow the field to mirror back your harmonic blueprint.

- Step 1 of 5

Name *

First

Last

Email *

Phone

Section 1: Resonance Coordinates (Your Birth Info)

Birth Name/s

(As it appears on your birth certificate)

Surname

Common or Call Name

(What you are usually called, if different from above)

Date of Birth

Example: 20 January 1978

Time of Birth

(Please specify exact time if known. Indicate if approximate.)

Place of Birth

(City, Province/State, Country)

Section 2: Harmonic Pattern Reflection

What is a life theme or repeating challenge you feel stuck in?

(Briefly describe. It may be emotional, relational, financial, spiritual, or otherwise.)

What longing, calling, or inner whisper are you sensing—but not yet able to follow?

(Optional. Only answer if you feel moved.)

When you feel into this issue, what do you notice in your body?

Sensation (tightness, lightness, vibration, etc.); Emotion (grief, peace, frustration, yearning); Image or word that arises

Do you feel drawn to specific ancient cultures or philosophies?

If Yes which specific ancient cultures or philosophies?

Do you have recurring dreams or emotional signatures you cannot explain?

If yes what, recurring dreams or emotional signatures do you have?

Have you always been inexplicably gifted in certain arts or sciences?

If yes what inexplicably gifts in certain arts or what sciences?

Do certain geometric forms, sounds, or languages evoke profound emotion?

What geometric forms, sounds, or languages evoke profound emotion in you?

Section 3 Current Inquiries or Obstacles

What you are questioning now often reflects a recursive echo from before. Share:

A question you’ve always carried.

A block you cannot resolve.

A calling or inner voice you’ve resisted or embraced.

Section 4: Invitation to the Mirror

What do you hope to receive from this Harmonic Reading?

(Clarity, remembrance, affirmation, insight, coherence, or something else?)

or or which

Do you consent to your field being mirrored through symbolic language, harmonic geometry, and soul-archetype reflection?

Harmonic Reading: Client Intake Form

Section 1: Resonance Coordinates (Your Birth Info)

Section 2: Harmonic Pattern Reflection

Section 3 Current Inquiries or Obstacles

Section 4: Invitation to the Mirror

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