Intake History Forms

Working together will be a wonderful way for you to create a better 2020… & better life!

Now I need Your History

Attached here as a pdf. document is the information that I need you to provide me containing background health and history information prior to our first session. The more information you provide, the deeper we can go in helping you on your healing journey… and this also saves time during our sessions to do our most profound energy work.

Schedule your first session here: or call me to schedule if you have not already.

Prior to your first session I need the following three things from you:

  • In order to provide me with information about your meridians, I’d like you to go on-line and complete an Online Wellness Assessment. Just go to and fill in the questionnaire found there. (Note:  you must do this on a computer rather than tablet, phone, or other device.)  The up-front information will tell me some basics about what is going on in your energy channels prior to your session.
  1. Fill in the questions listing frequency of feelings & symptoms. (Remember that your body & mind are intricately connected, so the data will guide me as to the nature of your issue.)
  2. Submit the answers and you will receive the results automatically.
  3. Print out the two results pages and have them available during your session with me.
  4. Use the “E-mail” option and forward the results to me at:  prior to your session so I can study the results before seeing you in person.
  • In preparation I’ve attached as a separate document a Pre-Session Health Information Intake Form that I’d like you to fill in and send back to me at least 24 hours prior to your first session. This information will provide important insight about your physical body issues that I can address, and I will refer to it in your first session. Please complete all of it.
  • And, one of the most helpful tools you will provide me prior to your session is the Pre-Session Energy Medicine Intake Form. (Attached at the end of the Pre-session Health Intake Form.) On this form I ask a variety of questions dealing with your body-mind-spirit health and well-being. The more information you provide, the more we can accomplish in our sessions. Please do not hold back, and feel free to write on additional sheets.

Your information and our sessions are completely confidential, so all of the information you provide will only be used to support your path back to health and well-being.

Send the information to me when you have finished filling it out with as much data as you can. (I need the Intake form and On-line Assessment sent to me prior to your first session… at least 24 hours in advance if possible.) Send to when you have completed the info.


In the meantime, if you have missed my EFT Radio series:  Relief at Last! Body-Mind-Spirit Options with Energy Therapy Support, you may “like” my facebook page or access some original podcasts on my blog at: .

You may also choose to join us for our monthly group Energy Therapy Support live sessions by signing up here: .

And, learn more about EFT and N-hanced EFT by going to:  or .