Questionnaire

First name

Last name

Email

Birthday

Month

Day

Year

Phone

How did you hear about my services?

Have you experienced an Emotion Code or Body Code session, or other energy work before? If yes, what kind?

Do you believe in a Higher Power? If yes, what name(s) do you prefer using (ex: God, Source, Universe, Spirit, etc)

Please list your top 3-5 issues you would like to address. These could include any health or emotional struggles, limiting beliefs, relationship issues (past or present), work or money related issues, or anything else that might be significant.

Do you have any comments or questions you'd like addressed prior to our first session?