CLIENT INTAKE FORM
Please complete the following before we start your session. Any information shared is for the purpose of conversation only, and will be kept in confidence.
Name:
Email:
Phone:
Age : Date of Birth: Brief Description of Desired Outcome or Intention for Session
Please list any conditions, surgeries or medications that you feel I need to be aware of.
By Pressing Submit You Aknowledge This Client Agreement Below: I agree to communicate with my practitioner. I understand that my practitioner does not treat or diagnose any condition or disease. I understand that energy work is not a substitute for medical care.
Questons, Comments:| Please email me directly at dagnystjohn@gmail.com
All payment is due at the time of service. Cancellation notice required 48 hours prior to appointment or a “no show” fee will be applied.