Online Energy Balance Interest Form

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Full name

Phone number

I am 18 years old or older.

Yes

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Have you ever done energy work with other facilitators?

Yes

Maybe

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What other alternative practices have you participated in?

Tell a little bit about what you might be looking for with this service?

How did you hear about this service?

I recognize that Stephanie Andersen is a guide and a facilitator of energy balancing. As a facilitator she might see, feel, and know where energy is out of balance and help me become aware of this. I acknowledge that I am responsible for my own energy and balancing my own energy with her help and guidance. Please type your name below indicating you understand these terms. Thank you. I will reach out to you shortly to set up an appointment.

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