Work With Me Questionnaire

This application is to work personally with Mira Kelley to clear your karma, your blocks and your limitations and to rapidly change your life, and manifest your goals, so you can live the life of your dreams now.

Please fill out all questions below and we will contact you to book a discovery call or to provide you with additional information.

Get Ready! Your life will change fast!

First Name:*

Last Name:*



What area is the sources of struggle, challenge or concern in your life right now where you want immediate transformation in? *
 Love & Relationships Money & Abundance Soul Purpose & Career Empowered Voice (Thyroid, TMJ and Speaking in front of People) Health Manifesting Your Dream Spiritual Growth

Please specify in detail how this problem is affecting your life?*

What changes do you most desire having made 6 months from now?*

What will be possible and available to you once you have made these changes?*

Are you ready to heal your challenges, awaken to your power to manifest your life and create the fulfilling, joyful and expansive life of your dreams?*
 Yes I think so

What made you decide this?*

What are the intentions and goals that you would like to accomplish in 3 years?*

Are you willing to do what it takes to make those intentions and goals a reality?*
 Yes Maybe. I'm not sure No

Are you truly ready to invest your time, your effort and your money to transform your life and to make your dreams a reality?*
 Yes You know it! Where do I sign up? All of the above Maybe. Not sure yet

How did you hear about me?*

On a scale of 0 to 10 (10 being the most) how excited are you to work with me and to truly change your life?*

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Ways to Work With Me


Past life regression is a gentle yet powerful process that allows people to heal emotional and physical issues. You will visit past, parallel and future lives. By seeing the big picture of your soul’s journey and learning your lessons you become profoundly empowered to transform your life.

To learn more about it please see past life regression therapy and read my book Beyond Past Lives.

I offer in person 1 on 1 past life regression sessions in Los Angeles, CA.

I also offer 1 on 1 personal past life regression sessions over video Zoom. These sessions are just as effective, while you are comfortable at home.

To schedule your regression session please email me using the contact form above.


Coaching with me will change your life fast!

My coaching programs blends proven scientific and spiritual principles that are specifically designed to guide you to rapidly reach your goals and to live the life of your dreams.

I offer group and private coaching in the following areas:

  • Clear Your Karma
  • Stop The Abandonment and Attract True Love
  • Unlimited Wealth
  • Live Your Purpose
  • Empower Your Voice
  • Restore Your Health Now
  • Manifest Miracles
  • Self-Love and Confidence
  • Spiritual Growth

Private coaching is for you if you desire dedicated time and focused attention devoted solely to you and your transformational process.

If you’re ready to make a commitment to this transformational process, and an investment in yourself in order to live the life you deserve, please email me using the form above.
My coaching programs are by invitation only. To schedule your discovery call for us to speak please email me using the contact form above. This call will be the best 15/20 minutes you will spend on your goal all year. We’ll take a look at where you are now; where do you want to go; what is holding you back and what you need to do to reach your goals. And if we think it is a good fit, I’ll invite you to become one of my clients. If not, you invested the best 15/20 minutes you’ll spend on your goal all year.

I offer private and group coaching over video Zoom.


On your VIP Day, we will spend 6 hours together digging deep and creating changes in your life.

We can hold your VIP Day in person in Los Angeles, CA or over video Zoom.

Our focus will be exclusively on you to release the baggage of the past and to create a new life for you. We will use all my tools — past life regression, coaching, tapping, meditation and you will feel and see the results. You will leave feeling renewed, empowered and freer.

To schedule your VIP Day please email me using the contact form above.


Mira, I wanted to thank you so much for my session today. I can honestly say it was life changing. I would never in a million years have expected what I experienced today. What a powerful emotional release! Of emotions that I never even knew were within me. Thank you for your gentle nature and kind and loving heart. I felt so safe with you. You held such a beautiful space. I’m still processing everything that happened, bits are slowly coming back to me. I cannot even begin to put into words how powerful the process was and the clear insights that I received. I feel lighter and a deep sense of freedom. It feels like I’m ready for life to begin.

Thank you just doesn’t seem to sum up what I’m feeling right now.

Sending much love