Shamanic Therapy Registration
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 we'd advise you to give as much information as possible for the biggest obtainable energy shift and profound healing.
Address for your session: 45 School Lane, Lawford, Essex, CO11 2JA
Phone/ Mobile Number
Date of Birth
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 your 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
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