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"How can I help you..."

Form to Schedule Session

Name:

Age:

Location:

Email:

Phones:

Issue for focus? Or we can work on anything your Inner Wisdom chooses!

Choose type of session:
Distance(over phone)
Proxy

For Distance(Phone) sessions, provide a couple choices of date/time (Pacific Time please)
1.


2.

I am able to schedule sessions between 10:00 am and 9:00 pm, Tuesday through Sunday.

Thank you for reading my required disclaimer before you continue

The purpose of this procedure is to balance energy flow within the body, allowing greater comfort and efficiency. Sessions are not designed to treat, prescribe, cure or diagnose any illness. Nothing said or done by practitioner should be misconstrued to be such. By scheduling an appointment you give permission and consent to assist you in establishing improved energy balance, allowing YOUR body to heal itself. We are all responsible for our own healing.

Notes, anything you would like me to know:


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Updated 2015/01/19 19:16:02

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