A first step

Feel free to contact me

… and to tell me about yourself, and about what brought you here.

You

First name and surname *

Email *

Telephone number (with country code +41 / +33 / +32 / +352 …) *

Is this a WhatsApp number? *

Yes No

Reason for contact *

Date of birth *

City and country *

Spirituality / religion *

Health

Do you have (or have you had) any major health problems, such as heart problems, cancer, HIV, tuberculosis or any other terminal illness? *

Do you suffer from a mental illness, such as depression, mental instability or an intellectual disability? *

Do you take drugs or medication? *

Do you drink alcohol? *

Your path

Have you already been initiated into Shaktipat or any other Kundalini awakening by someone else? If so, who is the Guru and what is the lineage? *

Tell me about your family life (relationship, marriage, children…) – for those wishing to be initiated.

Three unretouched photos of yourself (face, upper body, full length) – for those wishing to be initiated. JPG, PNG or HEIC formats, 8 MB maximum per file.

Why do you seek to be initiated into this path? What is your inner desire? *

I agree that this information may be sent to Guru Jacques by email and kept for as long as is necessary to process my request, in accordance with the privacy policy. Privacy

A quick check: what is 3 + 4? *

Feel free to contact me

Thank you

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