Client Registration Form
Thank YOU for choosing YOU. Your healing has already begun.
Please fill in as many of these questions possible, if you'd prefer to leave any blank that is fine as well.
This is your process but I advise you to give as much information as possible for the biggest obtainable energy shift and profound healing.
Please click this link NOW to reserve your time slot in my calendar. DO THIS BEFORE YOU CLICK SUBMIT as it opens in a new tab!
You can ALSO find the calendar link on my Intstagram profile in bio and on the
Phone/ Mobile Number
Date of Birth
How would you like to receive your first call?
Skype - You will need to provide your Skype name bellow
Zoom - You will be sent an link via email to click and connect to the call
Facetime - You will need to send PASH a message on Facebook page, if not done so already
Whatsapp - You will need to provide your mobile number above
Skype name if chosen that option above
Medical History (including any current medication)
What is the main thing bothering you in your life presently
How do you think this is blocking you
Put one goal you would like achieved as an out come of this treatment
If not obvious, please state below how you will know when your goal has been reached
Please tick to give your consent to the storing and using of your personal information, for the sole purpose of us getting back in touch with you. All information is confidential and never shared with 3rd parties. Thank you.
I give consent
Send me a copy of my responses.
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