Healing Session Consult
Free 20 minute consult
Select a service category
LGBTQ umbrella
Intimacy and Partnership
Friends and Family
Holistic and Energy Work
Please select an appointment below
Personal Information
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
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Area Code
Phone Number
Get to know you!
All information is confidential and accepted with gratitude and integrity.
Please List your Time Zone
Describe the reason for seeking services.
Have you ever seen an Energy or Holistic facilitator? If so, what was your experience like?
Have you ever or currently been to a counselor/psychologist for this? If so, what was/is your experience like?
What are you looking to gain from our services?
Are you currently taking any medications? If yes, please identify them below:
Any special instructions?
All complimentary consult calls are 20 minutes in duration. Any initial consult that goes over 20 minutes will be subject to equal energy exchange to remain in integrity with our services.
Date Signed
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Day
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Date
Client's Signature
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