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Intuitive Energy Healing New Client Registration

Thank you for taking the time to complete this form. Your answers help me to better understand your needs and determine whether this healing modality is a good fit for you and how to proceed. You will be contacted to book a Discovery Call at a mutually convenient time. Please answer as honestly and fully as you can.

Before booking, please review and sign our Client Booking Policy and Consent

SECTION 1 Basic Details

First and Last Name

Date of birth

What is your email address?

What is your phone number?

City / Country

How did you hear about my work?

Section 2: What Brings You Here

What is bringing you to energy healing at this time?

What are you hoping will change or improve?

What would feeling better look like for you?

What feels most urgent or important right now?

Section 3: Current state

On a scale of 1 to 10, how intense is your distress, tension, or discomfort right now?

Where do you feel this most in your body?

How long have you been experiencing this?

Is this feeling constant, or does it come and go?

What helps even a little?

What makes it worse?

Section 4: Wellness Support History

Have you ever received energy healing, Reiki, bodywork, meditation support, somatic work, or similar support before?

If yes, what was helpful?

If yes, what was not helpful?

Are you currently working with a doctor, therapist, counselor, or other health professional?

Section 5: Comfort and boundaries

Are you comfortable with gentle hand contact if appropriate?

Do you prefer hands-off work only?

Are there any cultural, personal, or religious considerations I should be aware of?

Is there anything that would help you feel more safe or comfortable during session?

Section 6: Health and safety

Do you have any medical, physical, emotional, or mental health conditions that may affect session comfort or safety?

Are you currently experiencing a crisis or acute emergency?

Yes

If yes, what is your crisis or acute emergency?

Are you pregnant or recovering from a recent surgery or injury?

Is there anything else I should know to support your safety and comfort?

Additional information

Do you prefer in-person sessions or only remote?

Is there anything else you want me to know before the discovery call?