Nature Spirits Consultation Form
It only takes about 5 mins.
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Email *
Mobile *
Name *
Year of Birth *
Village/ City you live in? (include also here if you require a home visit due to mobility/transport issues) There may be an extra cost for this service *
What is your reason for seeking energy healing / spiritual mentorship? *
Required
Have you had an energy healing treatment before? *
How would you rate your general state of health? *
How would you rate your stress levels? *
Low
High
How would you rate your sleep pattern? *
Very good
Poor
How often do you feel fatigued? *
Rarely
All the time
How do you rate your ability to relax? *
Very good
Poor
Do you meditate? *
How would you rate your general sense of happiness? *
Mostly happy and positive
Mostly low and sad
How would you rate your diet? *
Very healthy
Not healthy at all
How much water do you drink per day? *
Optional Extra info:
2 litres
Only in teas
Are you pregnant?  *
Unfortunately I am unable to treat anyone who has a pace maker or currently undergoing chemotherapy. I can help you after treatment. Choose n/a if this does not apply to you. *
Please tick any issues that apply: *
Required
Are you currently under Doctors care for a specific reason? *
Are you taking any medication? *
Details of medication & diagnosis
List any previous major illnesses, accidents, surgeries or broken bones or n/a *
Please state any areas of physical pain or discomfort at present or n/a *
Are you hypersensitive to sound? (I may use sound instruments / music during an energy healing session) *
Are you hypersensitive to sage/palo santo/ incense smoke? *
Any other relevant information, such as family history, traumas, counselling etc please share here or put n/a.  *
Next of Kin Name *
Next of Kin Telephone Number (please double check) *
Please see website for any further information on what to expect during and after a treatment before reading and signing the following client declaration.
Client Declaration
By signing this form I give my consent to Energy healing and / or spiritual mentoring.

I declare that the information I have given is correct and that as far as I am aware I can undertake treatment without adverse effects. I have checked with my GP if on any medication/ treatments.

I must communicate any levels of discomfort during any session.

I understand that any complementary therapy treatment does not substitute medical treatment. I am fully aware of what to expect and am willing to proceed.

I hereby indemnify Louise Beattie (Lulu) of Nature Spirits against all adverse reactions or side effects sustained as a result of any session.

Disclaimer: Any product or service via NSUK are not intended to diagnose, treat, cure, or prevent any disease. The information provided is not a substitute for a face-to-face consultation with your physician, and should not be construed as individual medical advice. Thank you


PRIVACY STATEMENT
Your personal information will be processed in line with the Data Protection Act 2018 and the General Data Protection Regulation (GDPR). It will not be disclosed to third parties for marketing purposes.
NSUK will only share your information with third party organisations on a lawful basis - for example, should a medical emergency arise.
NSUK will continue to hold your personal data on file for as long as you continue to receive treatments.
Any personal data held will be destroyed after two years of inactivity.
Your data is not processed for any further purposes other than those detailed in this statement.

Client Signature (PRINT NAME) *
Date *
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