** PAST LIFE PROFILE FORM **
is FAST, Convenient, and Affordable! Just use this SIMPLE Form to complete your Profile so you can see how you are now effected by your PAST LIVES! Results will be Emailed - see method of payment below.

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Personal Information
Name    
EMail Address    
Month of Birth      Year of Birth 
How did you hear of this Profile?

 

Why are you filling out this Profile?

 

What will this Profile do for you?

 

COMPLETE THE LISTS to Indicate Your Personal Preferences
Which Best Describes
Your Beliefs?

 

Your Favorite Ways to Spend
Free Time 		  
 
 
Your Favorite Sports
of All Time 		  
 
 
Your Favorite TV Shows
of All Time 		  
 
 
Your Favorite Movies
of All Time 		  
 
 
Your Favorite Books
of All Time 		  
 
 
Your Favorite Music
of All Time 		  
 
 
Your Favorite Art
of All Time 		  
 
 
Your Favorite Foods
of All Time 		  
 
 
Things You Find the
Most ATTRACTIVE
in Other People 		  
 
 
Things You HATE Most
in Other People 		  
 
 
FILL IN THE BLANKS to Complete the Following Sentences
Your three greatest talents - talents, skills, abilities, or whatever you naturally do very well - are
- (in order of importance):		  
 
 
Your three most wonderful qualities - as a person - whatever makes you unique/special - are
- (in order of importance):		  
 
 
If you could rid yourself forever of three chronic health problems-conditions - they would be
- (in order of importance):		  
 
 
If you could change three things about your body-mind (other than health), they would be
- (in order of importance):		  
 
 
If you were given a free plane ticket to visit any 3 places in the world, it would be
- (in order of preference):		  
 
 
If you could live any 3 places in the world, for the rest of your life, it would be
- (in order of preference):		  
 
 
If you could be magically given any three skills, abilities, or talents, that you do NOT have now, they would be
- (in order of preference):		  
 
 
If you could go back in time to witness an three historical events, it would be
- (in order of preference):		  
 
 
If you could go back in time to meet and talk with three historical figures, it would be
- (in order of preference):		  
 
 
If you were magically given the ability to speak any three foreign languages, it would be
- (in order of preference):		  
 
 
If you could live in any type of house in the universe, it would be
- (fill in the blank):

    
If you could have any type of job
in the universe, it would be
- (fill in the blank):

    
ANSWER QUESTIONS with Yes, Maybe, No (Choose Only One)
  YES  MAYBE  NO

 1. Do you believe in past lives?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

 2. Do you believe in reincarnation?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

 3. Do you believe in karma?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

 4 Do you believe that you have lived before?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

 5. Did you have extremely well defined personality traits, especially as a child?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

 6. Were you born with three (3) or more medical conditions, especially birth defects?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

 7. Have you had / do you have any distinctive birthmarks (not caused by your delivery)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

 8. Have you had / do you have any skin discolorations (like moles or freckles)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

 9. Have you had / do you have any unexplainable, intense itching in your body?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

10. Have you had chronic headaches that cannot be treated by medicine?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

11. Have you had chronic pain-aches-discomfort that cannot be treated by medicine?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

12. Have you had nasal/lung congestion that cannot be treated by medicine?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

13. Have you ever been diagnosed with Fibromyalgia (similar to Chronic Fatigue)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

14. Have you had any severe overweight (obesity) or under weight (anorexia) problems?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

15. Have you had any areas of your body where you cannot stand to be touched?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

16. Have you had any areas of your body where you cannot wear tight fitting clothing?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

17. Have you had any abnormally weak parts in your body (relative to the rest of it)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

18. Have you had areas of your body where you have problems repeatedly?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

19. Have you been overly focused on survival (unduly worried about your next meal, etc)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

20. Have you had any serious money problems such as compulsive spending or hoarding?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

21. Have you had any serious problems with sex such as compulsive promiscuity or frigidity?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

22. Have you had any serious problems with time such as procrastination or punctuality?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

23. Have you had any serious problems with your duties by taking on too many or too few?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

24. Have you had serious problems controlling your anger, losing your temper, etc?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

25. Have you been plagued with the inability to trust yourself, others, the universe, or God?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

26. Have you had inappropriate fears (no imminent threat or no forseeable danger)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

27. Have you had any recurring "odd thoughts" (in the context of your life now)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

28. Have you had any memories that are strange or do not seem to be from this life?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

29. Have you been you diagnosed as having any form of Obsessive Compulsive Disorder (OCD)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

30. Have you been you diagnosed as having any phobias (massive fears interfering with daily life)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

31. Have you been you diagnosed as having any depression, anxiety, or panic problems?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

32. Have you been you diagnosed as having Multiple Personality Disorder (MPD)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

33. Have you been diagnosed with addictions (to food, drugs, sex, abusive relationships)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

34. Have you ever seriously considered or actually attempted suicide or self injury?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

35. Have you / do you have recurring dreams / nightmares about traumatic deaths?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

36. Have you ever seen yourself as another person in a dream (being dressed in "period" clothing")?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

37. Have you / do you find it hard to focus on the present moment (and/or living fully in now)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

38. Have you had / do you have any medical problems appearing suddenly/inexplicably?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

39. Have you had / do you have any other medical problems that cannot be solved by medicine?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

40. Do you have skills and abilities normally requiring study that come naturally to you?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

41. Have you ever been in a educational setting where you already knew more than the teacher?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

42. Do you have a compelling interest in a particular topic beginning in childhood?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

43. Could the pictures, poems, stories, or models you made as a child, relate to your past lives?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

44. Have you had a compulsion to do something that is "out of context" in your life today?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

45. Have you had a compelling or overwhelming desire to visit a place you have never been before?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

46. Have you had a compelling or overwhelming desire to do a job after being exposed to it once?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

47. Were you ever compelled to purchase what you did not want without knowing why?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

48. Have you found foreign languages are either abnormally difficult or especially easy to learn?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

49. Have you ever been to a place you have never visited and knew you had been there before?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

50. Have you ever just known about "things" which you would have no way of knowing about?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

51. Have you ever felt at home or abnormally anxious in a place you have never been?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

52. Have you had a strong attraction for or aversion to foods that you have never before eaten?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

53. Have you had a strong attraction for or aversion to animals that you have never before seen?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

54.< Have you had a strong attraction for or aversion to plants that you have never before seen?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

55. Have you had a strong attraction for or aversion to climates you have never before experienced?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

56. Have you had a strong attraction for or aversion to types of clothes (tight fitting vs loose)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

57. Have you had a strong attraction for or aversion to types of furniture (casual or formal)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

58. Have you had a strong attraction for or aversion to groups of people not explainable by this life?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

59. Have you had a strong attraction for or aversion to types of religion you have never practiced?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

60. Have you had a strong attraction for or aversion to types of meditation you have never practiced?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

61. Have you had any habits others consider odd and that you have no control over?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

62. Have you had any mannerisms others consider odd that you have no control over?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

63. Have you had / do you have any interests not considered "sex appropriate" by others?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

64. Have you had / do you have any interests not considered "age appropriate" by others?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

65. Has any art ever made you feel nostalgic for or triggered memories of other lives?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

66. Have sights ever triggered feelings that you cannot account for by your experiences in this life?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

67. Has any music ever made you feel nostalgic for or triggered memories of other lives?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

68. Have sounds ever triggered feelings that you cannot account for by your experiences in this life?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

69. Have you / do you like foods that are not from your local area (exotic, "foreign" foods)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

70. Have smells ever triggered feelings that you cannot account for by your experiences in this life?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

71. Have tastes ever triggered feelings that you cannot account for by your experiences in this life?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

72. Have touches ever triggered feelings that you cannot account for by your experiences in this life?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

73. Have you been / are you attracted to a historical period (ie. Renaissance, Civil War)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

74. Have you been / are you attracted to a certain historical figures (ie. Caesar, Cleopatra)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

75. Have you been / are you attracted to a certain historical clothing (ie. styles, colors)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

76. Do you keep antiques or other collectibles in your home from a particular historical period?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

77. Do you have any recreational activities that involve historical periods (reenactments, etc)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

78. Have you / do you enjoy books, movies, or television which are not about the present time?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

79. Have you ever had any strong reactions when viewing accounts about historical figures/events?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

80. Do you often meet people and have strong and instant reactions of like or dislike for them?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

81. Have you ever experienced "love at first sight" or an overwhelming fatal attraction?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

82. Have other people (especially children) ever had a strange or unexpected reaction to you?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

83. Did you have extreme reactions to family members when you were young (love or hate)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

84. Have you said something that you wondered where it came from (out of character)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

85. Have you been / are you your own harshest critic (as in always "beating yourself up inside")?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

86. Have you been a victim of rape or sexual abuse especially if you were injured?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

87. Have you been a victim of domestic violence, especially if you were seriously injured?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

88. Have you been / are you a victim of major, crime (such as robbery, arson, con game, etc)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

89. Have you ever been in a serious accident (car, sports, etc), especially if you were injured?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

90. Have you been / are you severely out of touch with your body's needs (neglecting yourself)?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

91. Have you / do you feel "out of step with the times" (as in "too old fashioned")?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

92. Did you ever feel that you could have been a member of the opposite sex?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

93. Did you ever feel that you could have been a member of another race?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

94. Did you ever feel that you could have been a member of another religion?
    (For What this Question Means, Click Here)
  YES  MAYBE  NO

95. Did you ever feel that you could have been a member of another nationality?
    (For What this Question Means, Click Here)
Any Other Information Relevant to this Profile
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Marlton, NJ 08053 USA
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