Before session form

Before session

All information is held strictest confidence. At no given point is information disclosed or shared without client’s written consent.

Full Name

First NameMiddle NameLast Name

DOB

DayMonthYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Format: xxxxxxxxx.

E-mail

make sure the email is correct - it is guarantee that you receive the message

Occupation

Health Problems

1. List Areas of Discomfort or Pain

2.Other problems

3. Describe the area in which you would like us to work?

4. On a scale from 1 to 10, how much do you want your health to improve?

5. Have you ever been in an accident (automobile, work, falls, etc.) ?

6. List all related treatments received for this injury.

7. Can we work in different body area than stated in point no.3 if will revealed during the session?

8. Did you have any energy healing sessions before, if so, when and what type of session?

What payment method you prefer?

If gift voucher please add voucher number

I agree with terms&conditions on myangels.uk / sourcelovelight.co.uk website

Signature (Name&Surname)