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Emotion Code Client Intake

Name

Email

Date of Birth

What concern, theme, or area would you like this session to focus on?

How long have you been experiencing this issue?

On a scale of 1-10, how intense does this issue feel right now? 1 = Barely noticeable, 10 = Overwhelming

On a scale of 1-10, how intense does this issue feel right now? 1 = Barely noticeable, 10 = Overwhelming

Have you ever received an Emotion Code session or any other energy healing before? If yes, please provide a brief description of your experience.

Do you experience any adverse reactions to magnets?

Do you experience any adverse reactions to magnets?

Are there any other current physical symptoms, stressors, or circumstances you would like me to be aware of before your session?

I acknowledge that the Emotion Code session I have purchased is a holistic wellness service intended to support my emotional, mental, physical, spiritual, and energetic well-being. I understand this service is not a substitute for medical advice, diagnosis, or treatment and that Amanda of Holistic Harmony does not claim to cure or treat any medical condition.
I agree to take full responsibility for my own health and wellness decisions. I understand that results vary from person to person and are not guaranteed. All sales are final and non-refundable.
I also understand that all content provided is the intellectual property of Holistic Harmony and may not be shared or reproduced without permission.

I acknowledge that the Emotion Code session I have purchased is a holistic wellness service intended to support my emotional, mental, physical, spiritual, and energetic well-being. I understand this service is not a substitute for medical advice, diagnosis, or treatment and that Amanda of Holistic Harmony does not claim to cure or treat any medical condition. I agree to take full responsibility for my own health and wellness decisions. I understand that results vary from person to person and are not guaranteed. All sales are final and non-refundable. I also understand that all content provided is the intellectual property of Holistic Harmony and may not be shared or reproduced without permission.