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Client Insight Form
Gathering client information to create an impactful nourishing session.  
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Email *
Full Name *
Phone Number and Time Zone *
Today's Date *
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How did you find out about me or who referred you? *
If you had not had a call with me please list dates and times for availability for a  call and/or session *
Have you visited my website to view the holistic services? *
What service are you applying for? Check more than 1 if applicable. *
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Have you had a consultation with me? *
Have you had energy work done before? *
Have you seen a psychic before?
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Do you agree to take responsibility for your own life and your own healing? *
Do you agree to listen with an open heart? *
Do you agree to decide for yourself what to do with the information provided? *
Do you agree that you are the only one responsible for any healing and growth? *
Do you give me permission to view your entire being; spiritually, emotionally, mentally and physically during our time together? *
Your purpose for working with me? *
What is your emotional block? *
What do you feel like your challenge is? *
What do you feel shame or guilt around? Please be honest and detailed. *
What do you feel fear or anger around? Please be honest and detailed. *
What do you feel stress or anxiety around? Please be honest and detailed. *
Do you have any physical ailments, had surgeries, pregnant, implants (metal of other wise) or any other issues? Please list and describe bodily sensations of all. *
How is the relationship with family? Please be honest and very detailed. *
What time a day do you feel most naturally energized, without caffeine or sugar? Please input as hours of the day. *
What time a day do you feel most naturally fatigued?  Please input as hours of the day. *
What emotional and/or pyshcial traumas have you experienced in this life that you can recall. Please be open , honest and detailed?     *
What Medications are you taking if applicable?
What would you like to know about your life path? *
Would you be interested in hosting a group session?
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What would you like to know about the power of gratitude and law of attraction? *
What tools are you looking to receive from a session with me? *
Are you invested in working with me for multiple sessions? *
Please address other questions/concerns here. *
A copy of your responses will be emailed to the address you provided.
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