New Coordinator Questionnaire

KOMITOR HEALING METHOD, INC. ● HEALING TOUCH FOR ANIMALS®
New Coordinator Questionnaire
Personal Information
Name
Mailing Address
City
State
Zip
Country
Home Phone
Cell Phone
When is the best time to reach you?
Email Address
example@example.com
What type of computer do you use?

PCMAC
What is the best way to reach you?
What levels of Healing Touch for Animals have you completed (if any)?
What levels of Healing Touch for Humans courses have you completed?
Are you affiliated with any other healing modality (if yes, please explain)?
Are you and ACTIVE member in any other organization?
Do you coordinate for any other organization (If yes, which organization)?
Do you have animals? (If yes, please list them)
What is your experience with horses?
What is your current occupation?
How many hours per week does your current occupation require?
Please describe how flexible your current employer is in order to allow you to work on HTA during business hours.
Is there anything else we should know about you?
Thank you – we look forward to working with you!!

© 1996 Komitor Healing Method, Inc., dba Healing Touch for Animals®, 1996. All rights reserved. (7/11)
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