Health Transformation - Client Intake
New Client Intake Form
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Email *
Have you ever worked with a Holistic Health Therapist before?  (If Yes, what for?) Including Nutrition, Acupuncture, Naturopath, Yoga, Fitness, Life Coach, etc. *
How long? Do you feel it worked for you?
Why do you feel that it did or didn't work?
What are your Personal Goals (Health, Emotions, Energy, Relationships, Business, Family, etc.) *
What are some of the struggles or blocks you feel you face in trying to achieving your goals? *
What are some Holistic Therapies you are interested in? *
Required
What would you like less of in your life? *
Do you have any specific health issues, injuries, diagnoses? *
Is there a particular area of the body where you are experiencing tension, stiffness, pain or other discomfort?
Are you on any specific Medications? Supplements? Nutraceuticals? *
If yes, how do you think it has affected your health? *
Are you ready to make shifts and new experiences with pathways to higher health? *
Where did you hear about or find these services? *
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