• Waking the Dream Intake Form


  • Lifestyle & Daily Experiences

  • Background & Personal History


  • Session Goals & Desired Experiences

  • Consent for Consultation

    By submitting this form and participating in consultation services from Waking the Dream, LLC and its practitioners, I agree to the following: I understand that personalized consulting sessions are not intended to diagnose or treat any medical condition or disease. I also understand that personalized consulting sessions are not a substitute for medical, psychological, or psychiatric evaluation, maintenance, or care. I understand that at all times I have the choice to participate in consultation sessions from Waking the Dream, LLC and that at any time I may cease to participate in said sessions without penalty, with the exception of monies owed for services rendered. Further, I agree to hold harmless Waking the Dream, LLC and its practitioners for any results of any consultations for which I voluntarily choose to participate. All personal information is kept secure and confidential.
  • Payment Policy

    By submitting this form and participating in consultation services from Waking the Dream, LLC and its practitioners, you agree to the following: Personalized consulting sessions are pre-paid or shall be paid at the time of services. Waking the Dream, LLC does not accept any forms of medical health insurance and is not a health care provider.
  • Cancellation Policy

    By submitting this form and participating in consultation services from Waking the Dream, LLC and its practitioners, you agree to the following: Personalized consulting sessions are subject to scheduling and availability. Payment is due in advance, or at the time of services. Cancellations should take place no less than 48 hours in advance of the scheduled session time. Should a cancellation occur less than 48 hours prior to the scheduled session, payment for the session shall still be required.
  • Reload
  • Should be Empty: