Energy Healing Session Client Intake Sheet
(Emotion Code/Body Code- In-Person/Distance Sessions)
Phone Number (Your contact number for purposes of communicating with our office)
Please specify which physical and/or emotional concern you wish to focus on during your session (If seeking Heart Wall removal services please indicate accordingly):
Please indicate the severity of each said ailment ranging from 1-10 (1= mild symptoms/minimal impact on quality of life, 10= severe symptoms/considerable impact on quality of life)
DISCLAIMER: Like all forms of energy healing, personal coaching and/or therapy the Emotion Code &/or the Body Code does not take the place of seeing a physician and/or business professional and is not designed to cure or treat disease or render legal advice. Your voluntary availment of this modality constitutes awareness that no representation contained in distributed informational materials or communicated during OLM sessions is intended as medical advice and should not be used for diagnosis or medical treatment and/or business advice. All information contained here and discussed during client session(s) are protected by our strict code of confidentiality. We are licensed via the Pastoral Medical Association (PMA) (License No# L.11759116) to provide pastoral services and complaints must be directed to the PMA at www.pmai.us or 866-206-8469 in the US & Canada.
We are OneLightMessenger- www.OneLightMessenger.com- Your Partner in "Living Your Light"-how did you hear about our services?
HealersLibrary.com (Global Practitioner Map)
Pastoral Medical Association Directory of Alternative Health & Medicine
Medical Professional Referral
Holistic event or workshop
Do Not Fill This Out