• Val Heart’s Soul Repair Program Assessment™ Questionnaire

    Please fill out as much of the confidential Questionnaire as you feel comfortable with. Your Program begins when you fill out the Questionnaire because it sets a baseline starting point for our work together. It also sets your intention for what you want to have happen, the results you want achieve from this Program. The information you provide will be held in the strictest of confidence and will not be shared with any third parties.
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  • Instructions:

    Below is a list of symptoms and conditions which may seem unrelated to the purpose of your Program. You'll notice that there seem to be repeated questions in the different categories. This is not a mistake, it's done intentionally to help your BodyMind notice that different systems, organs, glands, etc., can be involved in different symptoms. Please check the symptoms you have experienced as chronic (recurrent symptoms) and/or acute (symptoms you have now), or none if you haven't ever experienced that problem. 

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  • Toxicity Exposure

    Rate each of the following situations based upon your environmental profile for the past 120 days. 0 - Never, 1 - Rarely, 2 - Monthly, 3 - Weekly, 4 - Daily
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  • CONSENT FOR SOUL REPAIR PROGRAM SESSIONS WITH VAL HEART

    You will have already signed your contract agreement which outlines these and other important aspects of this Program. If you haven't done that, please contact Val at contactval@valheart.com right away. This consent form highlights various aspects Val feels are important to be sure we are in alignment with your work together.
  • PLEASE take a moment to carefully read the following information and indicate your agreement by checking the boxes below:

    "I understand that Val’s approach to health is that of a holistic nature and I've familiarized myself with her work.

    She addresses each individual as a unique being with diverse needs mentally, physically, emotionally and spiritually. There is no assurance that either I or my animal will feel better or obtain improvement with our presenting condition(s). Val’s intent is to assist me and them with as much ease and grace as possible in as few sessions as possible. For some this may occur in single session, for others it may take longer. I and my animals are ultimately responsible for our personal healing and well-being.

    If at any time I feel uncomfortable with the process and training or assignments between sessions, it is my responsibility to inform her.

    Self-care and self love is an extremely important part of my healing process, and I know Val respects and supports me in this. I am willing to make appropriate lifestyle changes as needed.

    I also understand that while my and/or my animals may immediately experience positive changes and results, we could also experience temporary difficulties as our bodies repair themselves. Our symptoms may intensify for a short period before relief is felt, so I won’t be alarmed if this happens. I will be encouraged because these symptoms tell me that the therapies are working, supporting the body as it makes changes, addressing problems more aggressively.

    I also agree to be patient and gentle with myself and my animal as we process and integrate these changes. If our bodies must create new neural pathways or generate new tissue or cells as it rebuilds healthier organs, joints, etc., this may take a few weeks or months, depending on the complexity of the task.

    If for any reason I am unable or unwilling to allow the time I need to heal and do my assignments after a session, I will tell Val before our session.

    I affirm that I have stated all known medical conditions, and have answered all questions honestly and to the best of my ability. I understand that this is not a substitute for medical examination and diagnosis. I understand that Val does not diagnose illness, disease or any other physical or mental disorder. Likewise, she does not prescribe medical treatments or pharmaceuticals. Any information provided is for educational purposes only.

     

    NO SHOWS, RESCHEDULING AND CANCELLATIONS:

    Your investment in this Program is non-refundable. You may reschedule up to 2 business days (Monday - Friday, not counting holidays) before your scheduled session(s). Late cancellations and missed appointments for any reason within 2 business days of appointment time forfeits the session / money paid. Additional fees will be charged as outlined in our Agreement for makeup sessions.  

  • Please Review my Coaching Policies and the One on One Coaching Agreement

    https://valheart.com/private-coaching-policies/

    https://valheart.com/one-on-one-coaching-agreement/

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