Holistic Energy Healing Request Form

Holistic Energy Healing Request Form

Please complete the following form to request an Energy Healing Session. Once completed, I will reach out to you via email (hello@thewanderparlour.com) within 24-48 hours with how to book your appointment. Thank you and I look forward to working with you!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Is this your first time receiving Energy Healing?*

YesNo
What other types of Energy Healing have you received before? (select all that apply)*

ReikiAcupunctureAcupressureQigongSound HealingPranic HealingShamanic HealingQuantum HealingChakra BalancingEmotional Freedom TechniquesCranial Sacral TherapyTherapeutic TouchOther
What is the main reason you are interested in receiving an Energy Healing Session?*
What time of day works best for you?*

MorningAfternoonEvening
Should be Empty: