Client Intake Form
Full Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Date
-
Month
-
Day
Year
Date
Email Address
example@example.com
1. What brings you to this session? (Your main goals, intentions, or challenges you want to work on)
2. What are your biggest dreams and desires for your life and health?
3. What are your biggest fears or struggles right now?
4. What changes do you want to make in your life?
5. What interests you from what I offer that you've never tried before?
6. What have you tried before in your healing journey? (This can include energy healing, nutrition, movement, therapy, etc.)
7. Have you experienced energy healing before?
8. Are you open to making lifestyle or dietary changes to support your healing?
9. Is there anything else you'd like me to know before we begin?
Submit
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