INTAKE FORM for ATLAS BALANCING and ENERGY MEDICINE       for ANIMAL COMPANIONS
                                                                         
Jody Wallace, LMT, Energy Medicine Practitioner for people and their animal companions.
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What is the name and age of the animal? *
What is the species and breed of the animal?
Owner's name: *
Email : *
Address : *
Phone number : *
Your Concerns, reason for the session : *
Health concerns, diseases,  physical ailments, disorders in the bone structure, etc. Please specify.
Life history; Problems or concerns on mental emotional levels, rescue animals, past traumas, habits, fears, etc. :
Is the animal pregnant? *
Optional: Permission to talk with Vet  (if needed), and contact information:
Please add any additional concerns or comments you feel will help the session :
Once we set up your appointment, please pay in advance for distance sessions at my Paypal link on my website.
DISCLAIMER: Atlas Balancing does not replace medical treatment, nor does it claim to heal an animal in any form. Its sole function is to support the SELF HEALING capacities of the animal, physically and psychologically as well as working on the energetic levels. The protocol is an energetic one that uses intention, sound, and light touch, but can also be done in a distance session if need be. Please continue any ongoing medical treatments and care. Atlas Balancing is not a medical therapy and  does not involve a diagnostic routine, and no diseases, symptoms or sickness are treated specifically. It is not a chiropractic or osteopathic manipulation. No promises of cure have been made. I have been informed prior the session about possible physical reactions that the animal might have during the self healing process. Price for cats and dogs, other pets: $100 (for first initial session)  Horses: $120 (First initial session) *
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