Austin Reiki and Energy Healing Services

Client Intake Form

* Required Field
* Date:
* First and Last Name:
* Mailing Address:
* Preferred Phone:
Alternate Phone:
* Email Address:
Birth Date:
Age:
How did you hear about PathFinder?
On a scale of 1-10, with 1 being the lowest, select the number that represents how you would rate your level of stress most days. 1
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10
* Which of the following generally describes what you would like most to accomplish from your energy therapy sessions? General stress relief and rebalancing
Physical healing
Emotional healing or issues
Spiritual development or consciousness expansion
All of the above
Not sure
Comments or additional information you would like to share about yourself or your situation
* May I call or email you after a session to ask how you are doing? Yes
No
If you answered "yes" above, which contact method do you prefer? Phone
Email
Either (no preference)
* Medical Disclosure: Energy healing is not medical treatment & does not replace appropriate medical care by a licensed professional. Energy therapists do not diagnose or treat medical conditions & will not interfere with treatment by licensed professionals. Energy healing is used only to balance energy fields of the body. It is your full responsibility to seek & use medical care as you would see fit to do without holistic complementary practices. I have read and understand the medical disclosure stated here.