New Client FormPlease complete prior to appointment. Today's Date * MM DD YYYY Name * First Name Last Name Phone * Country (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date, Time and Place of Birth Age * Occupation * Relationship Status What are your religious or spiritual beliefs (if any)? Emergency Contact (name and phone number) * How did you find me? Have you tried EFT before? * If so, with a practitioner or on your own? Do you have any current health concerns? * Are you currently taking any medications or supplements? If yes, for what conditions? * Any prior surgeries? * Are you currently or have you previously been under the care of a psychologist or psychiatrist? If yes, for what condition(s)? * Please list any emotional/mental stresses you have experienced (e.g. loss of loved ones, trauma, legal or financial concerns, separation/divorce, major illnesses, other). * What areas of your life would you like to improve (e.g. relationships, finances, work, health, pain, other)? * What emotions would you like to address (e.g. anger, fear, resentment, sadness, hurt, grief, guilt, jealousy, loss, disappointment, frustration, stress or other)? * What is the result that you would like to get from these sessions? * Is there a situation, issue, memory or physical problem you would like us to start with? * Anything else I should be aware of before we start working together? * I agree to the terms and conditions set out in the Client Consent & Waiver Form linked directly below this form. * I agree Thank you! I look forward to working with you. Client Consent & Waiver Form