New Client Intake Form 
Please answer all questions and Type name to sign at the bottom 
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Email *
Name First and Last (Maiden Name) *
Phone Number *
Is english your first language?  *
Physical Address
Referrer Name
Birthday *
MM
/
DD
/
YYYY
Your goals working with Michael
The less Michael knows the better, however if you have any imbalances of concern (eg. Anxiety, Depression, physical/ energetic pain.. please share here
3 Things you are grateful for! *
Age *
What’s your happiness on a scale of 1-10? *
Not happy at all 😫
Very happy! 😁
What’s your pain level on a scale of 1-10 *
No Pain at all 🤩
Extreme Pain 🤕
By answering this question you understand and agree to the following: Michael McPherson is NOT a medical doctor nor does he claim to be one. What is said during the session is just a suggestion on how to help your body with the imbalances. These suggestions should NOT be taken as medical advice. If you have an emergency please contact your primary care doctor or visit your local ER *
ALL sessions are confidential and fall under HIPAA guidelines and compliance. video, email and all other documents fall under these guidelines.  *
By answering this question you understand and agree that ALL payments are made up front before any services are rendered.  *
If a payment plan has been agreed upon. All payments must be made within 7 days of recepit of invoice! If payment has not been made within 7 days, client understands that all money(s) will be Forfeited and the opportunity to work with Michael revoked.  *
Notice of cancellation must be provided 24 hours before scheduled session time to avoid being charged a $50 cancellation fee.   *
By answering this question you understand and agree that Michael and Wholeistic Lyfe LLC does NOT issue refunds  *
By electronically signing your signature here. You understand and agree to all the terms and conditions stated on this form. You also agree and understand that this is a legal binging Instrument and agreement with Lyfe Holdings LLC.  *
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