Intake Form
Language
  • English (UK)
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  • New Client Intake Form

    Please complete to the best of your ability. If there are questions that you would prefer not to answer or you do not know the answer then just leave them blank. We will review your submission and get in contact as soon as possible.
  • Date of Birth*
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  • Contact Information

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  • Health Information and History

  • If you have a current health condition, or have been diagnosed with one in the past, (eg. heart disease, diabetes, cancer, etc...) 

    Please list here in as much detail as possible making a distinction between what you are currently experiencing and what may be important to know from your past health history. How long have you been struggling with the issue(s)? 

  • Please indicate if you are CURRENTLY experiencing any of the following,

  • Muskuloskeletal
  • Nose and Sinus
  • Skin
  • Cardiovascular System
  • Mouth and Throat
  • Neurological
  • Respiratory
  • Endocrine System
  • Mental/Emotional Health
  • Urinary System
  • Digestive System
  • Immune System
  • Are you currently pregnant?*
  • Are you trying to become pregnant?*

  • **To share Medical Images, Blood Tests & Other Documents that you believe will be helpful for Johnny while reviewing your case, please send directly to our e-mail themedicalhealer@gmail.com **

  • Health Assessment and Medical Information

  • Are you a smoker?*
  • Do you use illicit drugs?*
  • Do you drink alcohol?*
  • Have you ever been to an energy practitioner before?*
  • Are you a practicing energy worker?*
  • Have you ever done energy work on another person before? (eg. clients, family members, friends)*

  • Home Environment

  • Are you currently in a toxic relationship or household?*
  • I understand that Johnny Batterson is an energy practitioner and that my individual results may differ from previous clients. Please be reminded that Johnny is not a Medical Doctor nor a certified health expert of any kind.*

  • Johnny Batterson works as a practitioner in energy-based healing and is not a medical doctor or licensed healthcare provider. Results will vary from person to person.

    This work requires commitment. By moving forward, you understand the importance of completing recommended sessions and following the guidance given. Your results are influenced by your openness and consistency throughout the process.

    To keep the work clear and effective, Johnny does not work alongside other energy practitioners or undisclosed treatment plans, as this can affect the sessions.

    You agree to approach this work with respect and genuine intent. Any attempt to harm others or Johnny himself, or engage in negative practices, will affect the sessions and prevent the work from supporting your desired outcome.

    You understand that excerpts from sessions, messages, or feedback you provide may be used for educational or promotional purposes. Everything is handled with care and remains anonymous unless you’ve given permission otherwise.

    You agree that any results experienced through this work will not be attributed to other practitioners or used to promote personal or external services in a way that misrepresents the source. If this occurs, we may end the working relationship and take further action if needed.

    By proceeding, you confirm that you are choosing to take part of your own free will. All services are non-refundable. While every effort is made to support you, results can’t be guaranteed. You accept full responsibility for your participation and release Johnny Batterson, The Medical Healer International, and associates from any liability, claims, or damages connected to your involvement.

  • I understand I must complete all recommended sessions and listen to the Guidance in order to achieve my desired outcome facilitated by this work. I take full responsibility for my own healing and results.*
  • I understand that if I engage in other energy practices, receive energy and/or frequency work or preform it myself that the healings can be affected and I can be set off course from my desired outcome. I acknowledge that if I am partaking in any other treatment plans and therapies that haven't been disclosed or agreed upon, results may be affected.*
  • I understand that it is important for Johnny & the Universal energies he works with, to be given credit and recognition for all positive improvements and progress made following the healing sessions. We ask for a testimonial either written or by video when results are seen in order to share his gift and continue helping others with similar conditions (Website, Facebook, Instagram, etc). We sometimes share positive messages, e-mails and voice notes that we receive. All documents and messages are published anonymously for the protection of our clients (unless otherwise stated). Your success is our only advertisement and is the only way Johnny can continue doing the work he was chosen for. If credit is given to another practitioner or to promote self work, we reserve the right to double the fees paid.*
  • I understand that if I engage in negative practices (witchcraft, black magic, voodoo, etc.), intend to sabotage or harm others or Johnny Batterson in any way, the healing will cease and I cannot expect my desired outcome.*
  • By agreeing and paying for this service you acknowledge that you have not be coerced, threatened or persuaded by Johnny Batterson, The Medical Healer International and associates to undergo or partake in any particular treatment, medication or substance and that it will be at your own risk and discretion; the service is non-refundable. You understand that Johnny will deliver his service to the best of his ability but cannot be held responsible for any deterioration, inability to heal the patient or in the event of death. You agree that by accepting these terms that you assume all risks of participating in this service and release Johnny Batterson, The Medical Healer International and associates from all liability including travel to and from the Service or any events incidental to this Service.*
  • Today's Date
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  • Thanks for taking the time to complete this intake form.

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