Senses of the Soul Health History Questionnaire
Each being is unique. No two persons are ever created exactly the same. Therefore, any attempt made to heal must be approached by treating each person individually according to their own particular patterns of disharmony.

About the Senses of the Soul Health History Questionnaire:

- You may want to grab a hot drink and allow at least 15 minutes to fill out this form, which was designed to create as complete a picture of you as possible.

- Your answers can always be adjusted later if you want to add something you forgot, or if you need to exit out before finishing you can submit your forms then return later to edit and finalize them.

- If you are not sure how to answer a questions, or it you prefer not to answer a question, leave it blank for now. We can discuss it during your initial consultation.

- All information will remain confidential and would only be released with your written consent.

- I will be looking at your nails, tongue and eyes, so please remove nail polish on you hands and do not wear perfume to your initial appointment.

Blessings,
Samantha

Samantha Orthlieb
Master Herbalist, Iridologist
Flower/Nature Essence Therapist
EAV Practitioner, BioEnergetic Medicine

Senses of the Soul Ltd
1 - 587 - 899 - SOUL (7685)
Unit 5, 70 Railway Street East
Cochrane, AB, T4C 2B5
samantha@sensesofthesoul.ca
www.sensesofthesoul.ca
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