Confidential Client Information Form
This information is kept strictly confidential.

* Denotes Required Fields
 

First Name*
Last Name*
Address*
City*
Province/State*
PC/Zip Code*
Telephone*
E-mail*
Birthday 
Religious/Spiritual Affiliations/Beliefs: 
Physical/Health Challenges 
(e.g.: back/neck/arm pain, headaches, weight, energy, sleep, disease)
Emotional Challenges 
(e.g.: grief, stress, fears, depressions, addictions)
Mental Challenges
(e.g.: memory, focus, learning difficulties)
Other Challenges 
(e.g.: money/prosperity, relationships, self-esteem, spiritual)
What are the top three issues that you would like to address in the session? *
What is missing from your life? What would make your life more fulfilling? 
What accomplishments must, in your opinion, occur during your lifetime so that you will consider your life to have been satisfying and well lived ... a life of few or no regrets? 
Disclaimer:
While EFT and TAT have produced remarkable results, they are still considered to be an alternative to traditional healing modalities. You are required to take complete responsibility for your own emotional, physical, and mental health and well-being, both during and after working with EFT and TAT. Further, Sheila Wright is not a licensed health professional, but offers EFT and TAT as a trained Meridian Energy Practitioner and as an Ordained Metaphysical Minister. EFT and TAT are not intended to be used as a replacement for medical treatment but can be used in conjunction with such treatment. You are encouraged to consult your doctor and/or therapist regarding your use of EFT and TAT.
I (Name)*on (Date)*have read the above disclaimer and agree by filling and submitting this web form to hold Sheila Wright harmless of any claims regarding the use of EFT and TAT.

 
 

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E-mail: sheila@fea.net 

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PSYCH-K...The Missing Peace In Your Life!
 

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Sheila Wright Consulting Services

Phone: Toll Free Canada and USA (888) 689-2378

Email: sheila@sheilawrightconsultingservices.com
 


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