Before session form

Before session

All information is held strictest confidence. At no given point is information disclosed or shared without client’s written consent.

Full Name *

First Name Middle Name Last Name

DOB *

Day Month Year

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number

E-mail *

Occupation

Health Problems

1. List Areas of Discomfort or Pain *

2.Other problems *

3. On a scale from 1 - 10 how much you want to your health to get better *

4. Have you ever been in an accident (automobile, work, falls, etc.) ? *

5. List all related treatments received for this injury.

6. Did you have any energy healing sessions before, if so, when and what type of session? *

I agree with terms&conditions on myangels.uk website *

Yes

Signature (Name&Surname)

Here is an option to pay for a session by payment card, if you paid for a session already then ignore that option.

My Products

30 Min Distant Energy Healing £ 30.00

60 Min Distant Energy Healing £ 55.00

30 Min Distant Energy Healing + Mini Reading £ 45.00

60 Min Distant Energy Healing + Mini Reading £ 70.00

Total £ 0.00