Name * First Name Last Name Email Address * Date of your session * MM DD YYYY What is your primary intention or objective for this session? * Please list all current concerns * What other treatment have you tried for your symptoms and what has been the result? * Have you seen a shamanic or energy healer before? * Yes No What is the one thing thing that keeps you up at night? * If this is your first session, how did you hear of us? Thank you! I'm so looking forward to meeting with you!xo~