• Senses of the Soul Health History Questionnaire

  • Each being is unique. No two persons are ever created exactly the same. Therefore, any attempt made to heal must be approached by treating each person individually according to their own particular patterns of disharmony.

    About the Senses of the Soul Health History Questionnaire:

    - You may want to grab a hot drink and allow at least 15 minutes to fill out this form, which was designed to create as complete a picture of you as possible.

    - Your answers can always be adjusted later if you want to add something you forgot, or if you need to exit out before finishing you can submit your forms then return later to edit and finalize them.

    - If you are not sure how to answer a question(s), or if you prefer not to answer a question, leave it blank for now. We can discuss it during your initial consultation.

    - All information will remain confidential and would only be released with your written consent.

    - I will be looking at your nails, tongue and eyes, so please remove nail polish on your hands and do not wear perfume to your initial appointment.

    Blessings,
    Samantha

    Samantha Orthlieb
    Master Herbalist, Iridologist
    Flower/Nature Essence Therapist
    EAV Practitioner, BioEnergetic Medicine

    Senses of the Soul Ltd
    1 - 587 - 899 - SOUL (7685)
    Unit 5, 70 Railway Street East
    Cochrane, AB, T4C 2B5
    samantha@sensesofthesoul.ca
    www.sensesofthesoul.ca

  • Personal Information

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  • Family History

  • Mother

  • Father

  • General Family History

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  • Your Health History

  • Diet

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  • Smoking/drugs

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  • Drinking

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  • Females only

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  • Males only

  • Everyone

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  • 24 HOUR CANCELLATION & PUNCTUALITY POLICY

    At Senses of the Soul Ltd our main focus is the quality of care we give. The information on this sheet is designed to best enable us to do that with your cooperation.

    CANCELLATION POLICY:
    We enforce a strict 24 hour cancellation policy. You will receive an email and text reminder of your appointment, which will also allow you to change or cancel your appointment if necessary. Please make sure to update your email and cell number information so you continue to receive your appointment reminders. Appointments not cancelled within 24 hours will be charged a $90.00 cancellation fee for adult appointments and $80.00 for a child or wise person appointments. Thank you in advance

    PUNCTUALITY POLICY:
    Our priority is to spend quality time with our clients. In order to accomplish this we schedule the appropriate time needed for each person, and do not overbook, nor do we "squeeze in" extra patients during your time. We cannot, therefore, accommodate a late patient. We respect each patients time. When one patient is late, we will not make the next patient wait. If you are late to your appointment, our practitioner may not be able to see you and you will be responsible for the payment in full. With this in mind, please leave a generous amount of time for traffic irregularities.

    We practice these policies because we have found them to benefit all of our clients. These policies help us maintain the integrity we feel is reflected in your experience at Senses of the Soul Ltd.

    PLEASE BE CLEAR, BY SIGNING THIS AGREEMENT YOU ARE CONSENTING TO COMPLY WITH THESE POLICIES.
    We thank you for being in agreement with us for the best way to serve you and look forward to a mutually productive a positive experience.

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