Please read and fill out the entire page carefully.

Whether you are just beginning this process or have already said YES to a revolutionary transformation, this form is a crucial step. Below you will find a series of questions. First, we will cover technical details to ensure a smooth process. Next, I've provided a series of heart-opening inquiries that will help me create an optimal experience for you. Please allow at least ten or fifteen minutes to complete these questions; this document does not save, and I don't want you to lose any valuable details! Once you complete and submit this form, I will be in touch so we can pull out our planners and find a schedule that works for both of us.

Hillary Rain, CHLC

Intake form / Client Registration

Name *
Please enter the name and / or website of the one who referred you to me or where you followed a link here. If there was none, simply put N/A.
What is your phone number?
What is your phone number?
International clients will be responsible for phone charges.
Preferred Mailing Address *
Preferred Mailing Address
Skype is free! If you do not have an account, go here to set one up: http://Skype.com
I schedule mentorship sessions according to our mutual availability Tuesday—Friday 9AM-2PM Central Standard Time. If you have special circumstances and need an alternate arrangement, please contact me to inquire. Mentorship sessions are held via phone or audio-only Skype. Unless specifically stated in your mentorship package, visual (face to face) Skype sessions are by prior agreement only and are subject to a tighter scheduling process.
If you are part of a class or program, the class or program topic will be our primary focus.
For the primary focus you indicated above, please describe some of the key issues or areas you’d like to explore with me. For example, if you indicated spirituality, please share a bit about your spiritual path, core philosophies and beliefs, and the worldview you uphold. If you indicated creativity, please share your main concern—do you have “writer’s block?” And so forth.
Enter anything you like!
I'm so honored you reached out and chose me as a potential holistic or spiritual life coach and mentor for you. Why do you want to work with me?
Please use this area to share anything you feel I need to know about you or your situation before we get started.

Soul work. Shadow work. Sacred Witness.

*All content ©2017 Hillary Rain