THETA INTAKE FORM | DeepIntuitiveHealing

Please complete this questionnaire prior to our scheduled session. All of your information is kept private and is used only to enrich your Theta Healing experience. We will never share or sell your personal information.

First Name

Email Address

Last Name

Date of Birth

Phone

When is your next scheduled appointment with May?

What called you to book this session with May? What would you like to work on?

Do you feel that you have any blockages?

Is there anything else you would like May to know?

Thank you for completing this questionnaire prior to our scheduled session. All of your information is kept private and is used only to enrich your Theta Healing experience. We will never share or sell your personal information.

Your Full Name

Today's Date

I declare that the info I’ve provided is accurate & complete

I have completed and submitted my Waiver of Liability. Click here for Waiver

Thanks for submitting!

THETA HEALING SESSIONS New Client Questionnaire

THETA HEALING SESSIONS
New Client Questionnaire