Cohoba Therapeutic Services, LLC. Intake Form
Please provide your details and select the services you're interested in to help us tailor your healing experience.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Which service(s) are you interested in?
*
Crystal Healing
Energy Work
Journey
Regression
Ancestral Healing
Other
What brings you to seek a healing service?
Is there anything else you would like to share or any specific goals for your session?
How did you hear about us?
Services provided by Cohoba Therapeutic Services, LLC, including crystal wellness, energy work, spiritual journeys, regression, ancestral healing, hypnosis, coaching, and related modalities, are intended to support personal growth, self-awareness, relaxation, and well-being. These services are complementary in nature and are not a substitute for medical, psychological, legal, or financial advice, diagnosis, or treatment. Participation is voluntary, and individual experiences and results may vary.
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