Name *

First Name

Last Name

Phone

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What areas would you like to focus on

Releasing Anxiety

Stress/ Anger Management

Trauma Release

Weight Loss

Stop Smoking

Energy & Flow

Sacred Healing Session

Soul Guidance

Other (Not Listed)

I The Client, Understand we will work together to create shifts.

Yes! I'm ready, Let's Do This!

Yes! I understand and willing to put in the effort

Yes! I'm ready to create my new foundations

I the Client understand and agree to provide a 24 hour notice or moreif I need to cancel or reschedule a session. If I do not, there will be a $25 fee I will be responsible to pay before having my next session. *

I have read, acknowledge and Agree to the terms