Subconscious Energy Transformation Assessment Form

Subconscious Energy Transformation Client Assessment

The S.E.T. Method
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Email*
example@example.com
Phone Number*

Area CodePhone Number
What type of work do you do, if any?
What is the biggest concern, priority or situation in your life RIGHT NOW?
What do you believe to be your biggest challenge in your life, OVERALL?
Do you have any repeating patterns in your life that you are aware of?
Have you experienced any childhood trauma such as abuse, neglect or abandonment?)
Please list any diagnosed medical conditions, current health challenges or allergies:
Please list anything more you want to share with me which might be useful in our work together...
PLEASE READ

This form is to assist me in recommending how many sessions would be most beneficial in our work together. By assessing what your intentions are and the outcome you would desire, I will suggest a package that will best suit your needs. Pricing ranges from $250 for a single (60 minute session - which I recommend for a very specific situation) to a 3-month program of support at $1100. Payment plans are available.

THE S.E.T METHOD POLICY

I am committed to your privacy. Anything discussed in our sessions, this form or follow up emails will remain completely confidential.

Refund/Package Policy

Session fees are non-refundable, including unused sessions. If an emergency occurs (or the timing becomes a inappropriate) I will happily put your unused sessions on hold for a period of 3 months – but this must be confirmed in writing (email).

Payment is due in order to hold and confirm the session appointments and packages are due in advance in full, unless a payment plan is discussed.
Should be Empty:

Subconscious Energy Transformation Client Assessment