Start your healing journey

1

What's your name?* This field is required.

First Name

Last Name

2

What specific health concerns are you looking to address?* This field is required.Describe any or all of your health concerns.

3

Approximately how long have you had these concerns?* This field is required.

Less than 6 months

6 months - 2 years

2 - 10 years

Decades

4

What would be the optimal outcome of working with us?* This field is required.E.g. Have abundant energy. Live a pain free life. Be able to play with my grandchildren.

5

Do you have a preference for a particular type of treatment or approach?* This field is required.Choose any option that you are open to trying.

Acupuncture/Chinese Medicine

Massage therapy

Compassionate Inquiry/Guided Self Inquiry

Mindful Movement Therapy (Qigong/Tai chi/Ba gua)

Holistic treatment program such as Healing Contract & Vitality Contract

I don't have any preference

6

What steps have you already taken to address your health concerns?E.g. Taking medication for it. Physio. HRT. You can skip this if you haven't taken any other steps yet.

7

In your experience, what has been the biggest obstacle to finding a long-term solution to your health concerns?* This field is required.If not sure, you can put that...

8

What's your email address?* This field is required.

example@example.com

9

What's your mobile number? * This field is required.

10

Which way do you prefer to be contacted?* This field is required.

Mobile

Email

11

When are you typically available to see a health practitioner?* This field is required.Office hours: 9am - 5pm

Week days before office hours

Week days after office hours

Saturdays

My hours are flexible

12

Is there anything else you would like to add before we wrap this up?You can leave this blank if you want