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*

DayMonth 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?*

What payment method you prefer?*

Bank TransferMoney TransferCar PaymentGift Voucher

If gift voucher please add voucher number

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.