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 is the one thing thing that keeps you up at night? Have you seen a change in your health since our last session? Yes No If yes, please describe What were the results from your homework? Was there homework you did not complete? Yes No If yes, please list items not completed What feelings, breakthroughs, insights, challenges, or changes in belief have you had since our last session? Thank you! I'm so looking forward to meeting with you!xo~