Client Intake Form
Name *
Your answer
Address *
Your answer
Email *
Your answer
Emergency Contact Name and Phone # *
Your answer
Have you ever had an Energy Healing Session before? *
If yes, when was your last session? *
Number of previous sessions? *
Your answer
Do you have a particular area of concern? *
Your answer
Are you sensitive to smells or fragrances? *
Are you sensitive to touch? *
Do you have difficulty lying on your back for the full session? *
What are your goals for this session? (This can be on a physical, emotional or spiritual level. This is something you can share below, or think about on the day of) *
Your answer
Do you have any additional comments or questions before your session? *
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service