PAST LIFE REGRESSION PROFILE

All information is completely confidential and will not be shared without Client’s written consent.

Full Name: ____________________________________________________ Date: ________________

City of Residence : __________________________ State: ________________________________

Country: ___________________ ; Email Address: __________________________________________

Best Contact Phone Number: ___________________________________________________________

If you are NOT in India, can you tell me how many hours ahead or behind you are from Indian Standard
Time (IST), which is (+) 5:30 Hrs ahead of GMT.

What are the best Days and Time for you to have a PLR Session? _________________________

Please answer the following questions to help with your PLR session:

1. What do you want or what outcome are you seeking to get from your PLR session?

2. What will this outcome do for you? How will it affect your life?

3. Describe any accidents or injuries you recall. Have you spent any time in the hospital?

4. Do you currently have any physical pain or discomfort?

5. Are there any people in your life that you are in conflict with?

6. What do you know about your birth experience?

7. What do you know much of your family history/heritage?

If you could go back in time to witness an historical event, it would be

1. ___________________________________

2. ___________________________________

3. ___________________________________

If you could go back in time to meet an historical figure, it would be

1. ___________________________________

2. ___________________________________

3. ___________________________________
YES-NO QUESTIONS: Indicate ONE answer ONLY by circling Y for Yes, M for Maybe, or N for No:

Y M N 1. Do you believe in the concept of past lives?

Y M N 2. Do you believe in the concept of karma?

Y M N 3. Do you believe that you have lived before?

Y M N 4. Have you had/do you have any distinctive birthmarks? If yes, please describe them and where
they are __________________________________________________________ .

Y M N 5. Do you have/have you had persistent, chronic headaches that cannot be treated by either
conventional or alternative medicine?

Y M N 6. Do you have/have you had any other persistent, chronic pain that cannot be treated by either
conventional or alternative medicine?

Y M N 7. Have you had/do you have severe over or under weight problems?

Y M N 8. Have you had/do you have areas of your body where you cannot stand to be touched? If yes,
please explain.
____________________________________________________________________________

Y M N 9. Have you had/do you have areas of your body where you cannot stand to wear tight fitting
clothing? If yes, please explain
____________________________________________________________________________

Y M N 10. Have you had/do you have serious problems with finances such as compulsive spending or
worry about money?

Y M N 11. Have you had/do you have serious problems controlling your anger (always impatient,
criticizing, losing your temper or regretting outbursts)?

Y M N 12. Have you been/are you constantly plagued with the inability to trust yourself, others, the
universe, or God (constantly plagued by fears of abandonment and betrayal)?

Y M N 13. Have you had/do you have inappropriate fears or phobias? If yes, what are they and what
triggers them? _____________________________________________________________________
_________________________________________________________________________________

Y M N 14. Have you been/are you diagnosed as having obsessive - compulsive disorder?

Y M N 15. Have you been/are you diagnosed as having any depression - anxiety?

Y M N 16. Have you been are you diagnosed as having multiple personality disorder?

Y M N 17. Have you been/are you diagnosed as having any physical, mental, or emotional addictions (to
food, drugs, sex, medicine, abusive relationships)?

Y M N 18. Have you had/do you have recurring dreams / nightmares? If yes, please describe them
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________

Y M N 19. Have you ever seen yourself as another person or a historical time in a dream? If yes, who?
__________________________________________________________________________________

Y M N 20. Have you had / do you have any medical problems that appeared suddenly and inexplicably
(in particular, any allergies or phobias)? If yes, please explain:
____________________________________________________________________________________
___________________________________________________________________________________

Y M N 21. Have you had / do you have any other medical problems (physical, mental, or emotional) that
cannot be solved? If yes, please explain.
____________________________________________________________________________________
__________________________________________________________________________________

Y M N 22. Do you have skills and abilities normally requiring study that come naturally to you?

Y M N 23. Have you ever found yourself in an educational setting where you came to learn about a
particular subject and found that you already knew more than the teacher?

Y M N 24. Do you have a compelling or overwhelming interest in a particular topic that began in your
childhood? If yes, what are they? _______________________________________________________

Y M N 25. Have you had / do you have an absolute compulsion to do something or go somewhere that is
completely out of context of your life today? If yes please explain
____________________________________________________________________________________
____________________________________________________________________

Y M N 26. Have you ever been to a place before - that you have never before visited in this lifetime –
and knew that you had been there before? If yes, where? ____________________________________
___________________________________________________________________________________

Y M N 27. Have you ever just known details about certain places, people, or things which you would
have no way of knowing about otherwise? Please explain:
____________________________________________________________________________________
____________________________________________________________________.

Y M N 28. Have you ever felt totally at home or abnormally anxious in a place you have never been? If
so, did you feel at home or abnormally anxious? And where did this take place?
___________________________________________________________________________________
___________________________________________________________________________________

If you answer yes to the following, please explain.

Y M N 29. Have you had/do you have either a strong attraction for or aversion to certain types of foods
you have never before eaten?
Y M N 30. Have you had/do you have either a strong attraction for or aversion to certain types of
climates that you have never experienced before in this lifetime?

Y M N 31. Have you had/do you have either a strong attraction for or aversion to certain types of
clothing (casual vs. formal, tight fitting vs. loose, etc.)?

Y M N 32. Have you had/do you have either a strong attraction for or aversion to certain types of
furniture?

Y M N 33. Have you had/do you have either a strong attraction for or aversion to a certain group of
people which is not explainable by the circumstances of your present life?

Y M N 34. Have you had/do you have either a strong attraction for or aversion to certain religions that
you have never before studied or practiced?

Y M N 35. Have you had/do you have any habits that others close to you consider odd or peculiar and
that you have no control over?

Y M N 36. Have you had/do you have any mannerisms that others close to you consider odd or
peculiar and that you have no control over?

Y M N 37. Have certain sights ever triggered feelings in you that you cannot account for by your
experiences in this lifetime? If yes, what sights?
______________________________________________________________________________

______________________________________________________________________________

Y M N 38. Have certain sounds ever triggered feelings in you that you cannot account for by
your experiences in this lifetime? If yes, what sounds?
______________________________________________________________________________
_

Y M N 39. Have certain smells ever triggered feelings in you that you cannot account for by your
experiences in this lifetime? If yes, what smells?
______________________________________________________________________________
_
Y M N 40. Have you kept / do you keep antiques or other collectibles in your home from a
particular historical period?

I understand that my story may be published in a book about Past Life Regression
stories or Social Media and I give permission to do so and my name WILL NOT be
used.

o By checking this box, you consent to participate in the process of Past-Life

Regression Therapy, under the direction of Satish Korabu. You also agree that you
have read, understand, and agree to the Methods, Payments, and Disclaimer
previously signed under the Past Life Regression Client Agreement.

Satish Korabu Client Name :

Client’s Signature