Energy Healing Follow-Up Form| Earth Horse Healing

Please fill out and submit this form at least 48 hours prior to your initial appointment. The information you provide is held as private and will not be shared without your expressed permission.

"*" indicates required fields

Contact Information

Please update your contact information, where necessary. Only the fields with a red asterisk are required.

Name*

First Last

Primary Phone

Previous Session Results

Please tell me about any significant improvements you have experienced as a result of our last session.

Please explain any physical, emotional and mental improvements you have experienced.*

Please explain any positive changes you have had in your relationships and lifestyle as a result of the healing session.*

Current Condition

Any health issues that you have going on presently.

Please describe your current health condition.*

Be sure to distinguish any new health issues that have presented since our last session.

Current Medical Diagnosis*

Please include an update of the previous medical diagnosis plus any new diagnosis you have had since then.

Current Medications and Supplements*

Please specify what each medication is for and duration of treatment.

Lifestyle

Any changes in daily diet or supplements since our last session?*

Any significant changes in your exersize program or lifestyle?*

Healing Session Focus

Please take the neccessary time to consider the following question.

What would you like to receive from our next healing session?*

Contact Information

Previous Session Results

Current Condition

Lifestyle

Healing Session Focus

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