CREATE YOUR PROFILE

PLEASE MATCH THE HEALER WITH

THE GENDER OF THE PERSON BEING MATCHED WITH A HEALER IS:

Other

DO YOU REQUIRE A SPECIFIC GENDER OF HEALING PRACTITIONER TO WORK WITH?

NAME OF CLIENT BEING MATCHED

First NameLast Name

YOUR NAME, IF DIFFERENT THAN ABOVE

First NameLast Name

YOUR EMAIL

example@example.com

YOUR PHONE NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

HOW DO YOU PREFER TO BE CONTACTED TO SCHEDULE YOUR FREE CONSULTATION?

CLIENT LIVES IN WHAT CITY, STATE, COUNTRY?

Street Address

Street Address Line 2

CityState / Province

Country

WHAT SYMPTOMS CAUSES YOU TO SEEK HEALING? (Select all that apply)

PLEASE SPECIFY:

Tell us a little more about your condition or situation.

HOW DID YOU FIND US?

Referred By

First NameLast Name - if known

I AGREE, I HAVE READ AND UNDERSTAND THE DISCLOSURE

DISCLOSURE: Wellness services are provided in compliance with Chapter 629 of the NRS. It is recommended that before beginning any wellness plan you notify your primary care physician (PCP) or other licensed health care professionals (LHCP) of your intent to use wellness services and the nature of this healing. SBT Energy Therapy® modality involves balancing the Subtle Energy Body and Physical body in different aspects. Aspects include: balancing of the emotional body, energy body, physical structures, pathogens, toxicity and more. This process is designed to identify imbalances using kinesiology and correct them through transmutation, thus bringing the body back into alignment, creating homeostasis so that the innate self-healing ability of the body will take over. The result of this is, pain, discomfort and malfunction of the body often disappear, organs function as they should, energy levels are raised, and emotional issues become manageable or nonexistent. Energy Therapy is not intended to replace medical treatment of a PCP or LHCP. It is recommended that if you are taking medications, you ask your PCP or other LHCP about any potential side effects, risks or conflicts between any medications or treatments and the wellness services you intend to receive. I understand I am unable to request a healer to be matched to anyone other than myself, my dependent under the age of 18, my pet, or a person whom is incapacitated which I have legal authority over their emotional and or physical wellbeing.

PLEASE GIVE YOUR CONSENT: