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 NameMiddle NameLast Name

DOB*

DayMonthYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

E-mail*

make sure the email is correct - it is guarantee that you receive the message

Occupation

Health Problems

1. List Areas of Discomfort or Pain *

2.Other problems*

3. Describe in which are we have to work?*

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

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

6. List all related treatments received for this injury.

7. Can we work in different body area than stated in point no.3 if will revealed during the session?*

YesNo

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

What payment method you prefer?*

Bank TransferMoney TransferWise / RevolutGift Voucher

If gift voucher please add voucher number

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

Yes

Signature (Name&Surname)