New Client Intake Form

New Client Intake Assessment Form

Must Be Completed And Submitted A Minimum Of 24 Hours Prior To Your First Appointment​

Please be sure to click "Submit" at the end

new client

By Clicking "Submit" You Are Consenting To Our Office Policies And Procedures And You Further Understand That This Treatment In No Way Should Take The Place Of Any Doctor's Treatment And You Accept This Responsibility Of Notifying Any Doctors Of This Treatment As A Compliment To Assist In Relaxation And Emotional Wellness Philosophy. $50 deposit is to secure the appointment time, it will be forfeited if cancelled 48 hours or more, if cancelled within 48 hours of appointment then the "short notice" cancellation fee will apply.

The "Submit" button will only be active once every question with a red star is answered. If not applicable to you then simply type in N/A

We operate in the interest of best efforts for all clients. The client understands that results may vary and are not guaranteed. We will employ multiple modes of emotional and spiritual healing as needed for the individual client and as assessed by our healing professionals. All sales are final and all contracts are valid. Our programs are designed to assist with the letting go of past unwanted issues and moving forward in life with a new positive outlook to achieve individual goals for the client.