Virtual Energy Healing Pre-Service Form
Thank you for taking this time to reflect and taking a step towards healing. Please use this opportunity to go within and identify the things that no longer serve you and you wish to let go. The more specific you are the more effective the Healing Haircut or Virtual Coaching will be. Reflect back to childhood and see if anything shows up today that might be triggered by past experiences.
Please enter a valid phone number.
Street Address Line 2
State / Province
Postal / Zip Code
What do you wish to let go of in regards to any relationship? Any emotions, memories, and/or people? Please list anything that comes up that no longer serves you and you wish to let go of.
Do you have any blocks, negative feelings, emotions, and/or frustrations that are brought up when you think of your career or job? If so, please list what comes to mind.
If you are experiencing any health related issues, please be specific and list whatever shows up for you.
In addition, please list the two most important things for you at this time that you wish to accomplish with a Healing Haircut.
Take a moment to determine how balanced and fulfilled you are in each area of your life.
Use 1 (being the least balanced) to 10 (being the most balanced).
Family (this includes immediate family and partners you live with).
Mental (this includes your mental health as well as how much knowledge/tools you have to draw from).
Social (this includes friends and anyone you are dating but don’t live with).
Physical (this includes health as well as self-image).
Vocational (this includes your work, career, or schooling).
Passion (this includes interests and hobbies).
Spiritual (this can mean anything you define as spiritual. It does not have to mean religious).
Please carefully read the cancellation policy: All deposits are non-refundable. The first deposit (50% of service) is due within 24 hours of booking, if it is not paid the appointment will be canceled. Should you need to reschedule you must do so through the online booking system or via email to firstname.lastname@example.org at least 24 hours before the appointment and the deposits paid will be transferable to the new appointment. Should you cancel or reschedule within 24 hours of the booked Online Service (including Virtual Coaching) the deposits are non-refundable and non-transferable. If the second deposit (50% of the service) is not paid at least 24 hours before the appointment the service will be cancelled and the first deposit is non-refundable and non-transferable. I have read and agree to these terms.
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