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Demographics
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Current Occupation
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How did you find Body for Life Healing
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Preferred method of contact
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Martial Status
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Living situation
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Energy Healing
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Have you ever received Reiki before?
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What other types of energy healing bodywork have you received?
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Describe any previous experience:
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Current Health
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Your current health:
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Reasons for Seeking Energy Healing - select all that apply:
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Current medical treatments
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Current treating physicians name and location
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Allergies
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Current Medications
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Interests/Self Care
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How do you currently relax?
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Hobbies and Interests
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Please list any supplements you take:
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Do you exercise?
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What type and how much?
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Do you consume: select all that apply
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How many hours a night do you sleep?
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