Prema Healing • Client Information

This information is kept Confidential.

Please complete the following information prior to your first session.

Method of Payment: Cash _____   Check ______        PayPal _______

Name: _____________________ ______________________ _________________

        Last                                First                                Middle

Home Address: _________________________________________, Apt No. _______

City: ________________________________ State _________________ Zip _________

Home Phone: _______ ____________________ Cell Phone: _______ ________________

                      Area                                                    Area

Email: ____________________________________________

Employer: _____________________________________ Position: ____________________

Address: _____________________________________ City: ____________________ St: ____

Work Phone: _____ _______________________


Emergency Contact: ______________________________ Phone: _____ ________________


Relationship to Client: ___________________________

Describe the “unwanted condition” that you wish to begin working upon: ______________________________________________________________________________

Use the back if you need more room to write.

Have you ever experienced Emotion Processing before? _______ If so, where and from whom?______________________________________________________________________________________________________________________________________________________

What do you wish to accomplish with Emotion Processing? ________________________ ______________________________________________________________________________


Informed Consent and Agreement for Services:

Emotion Processing, meditation, and mindfulness are healing processes that work with energy and consciousness. The provider (Prema Healing) functions as a guide and the client (you) actually do the work to balance and release emotions that hinder your ability to function to your capacity. Healing takes place when the root source of the unwanted condition is located and released by self-direction of consciousness to the obstructed area.

Initialed: _______

Client understands and agrees that Emotion Processing, Meditation, and Mindfulness practices are spiritual technologies. Prema Healing providers are not licensed to provide medical treatment, psychological or professional counseling services, or therapy services. If you are currently under the care of a medical doctor, health provider, or psychological or professional counselor you should consult with them regarding your respective care.

Initialed: ________

Because the success of emotion processing, meditation, and/or mindfulness is contingent upon the client’s (you’re) willingness to release the emotional blockages, we cannot offer a warrantee of success. Our services are provided on a best efforts basis and no warrantee or representation of success is either expressed or implied.

Initialed: _______

Payment for Services

Payment for services is expected upon the delivery unless other arrangements have been made prior to the session.


Dated: _____________________, 2011        Dated: ____________________, 2011

Responsible Party Phone (If different than client): _________  ________________________

Emotion Processing

We have prepared the following instructions to facilitate a more productive processing session and to serve as a pattern map for progress.

All sessions are confidential!

The processing will follow emotional strings that have run through your life. We will not necessarily work on processing from the list you will be compiling, but it will be helpful to make sure nothing is left out and will serve to jog your memory.

It will be helpful for you to prepare a list of events in your life that contain strong emotions:

Revisiting these situations may stir emotions and be painful, however it is these things that we are seeking to clear from your energy system. These emotional blockages hinder our ability to experience true healing and a higher level of consciousness.

If the process of compiling a list becomes too painful to review prior to a processing session, we can work without the list. However, the sessions may not be as productive as they would be with the preparation.

Prema Healing: Emotion Processing • Mindfulness • Meditation • Page |