Simple Healing Form — The Shed 888

Let’s get to know you and what we are working on together

Welcome to your healing session. To ensure we make the most out of our time together please take a moment and fill out this form. I am honoured to dive into your healing journey with you.

Sarah- AKA Ferris

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth

Emergency Contact, Name, Number & Relationship to you?

Instagram Handle

Have you previously tried any holistic healing modalities or therapies? If so, please specify.

How would you describe your current emotional and mental well-being?

Are there any particular emotions or patterns you would like to address?

How would you like to feel at the end of our session?

Are there any physical health concerns or conditions you would like me to be aware of before we begin?

Anything else you would like to share?

Health Care Terms and Conditions:

- By acknowledging this form, you acknowledge that the services provided are not a substitute for professional medical or mental health care. - The information provided in this form will be kept confidential and used solely for the purpose of tailoring the healing program to your specific needs. - It is important to communicate openly and honestly throughout the duration of the program to ensure the most effective support and guidance. -The practitioner reserves the right to modify or adjust the program as needed to best support the client's well-being. Do you agree with these Health Care Terms and Conditions?

Yes

Other

Payment for for your healing is due upon registration and is non-refundable.

Has a payment been made to Sarah Ross BSB: 0635 511 ACCOUNT 1032 3921

Payment have been made

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