Intake Forms | Dani's Divination

Human Client Intake Form

Danielle Lehr - Dani's Divination

Please complete the following form for human clients.

First name

Last name

Email

Phone

Birthday

Yes, subscribe me to your newsletter.

Current Medications/ Supplements:

Current Physical/Mental Health Conditions

Prior surgeries, injuries or traumatic events

Are you currently under the care of a physician or specialist?

Yes

No

If so, please specify what for if comfortable:

Have you ever experienced Reiki or any other Energy Healing?

Yes

No

Not sure

Do you have difficulty laying on your back for up to an hour?

Yes

No

Not Sure

Are you comfortable with me appropriately placing my hands on you during your session?

Yes

No

Please ask first

What are your goals while receiving energy healing/coaching?

Is there anything else you'd like me to know about while working with you?

I understand that Reiki and other healing modalities are alternative techniques for stress reduction and relaxation that can improve your health. My practitioner does not diagnose medical conditions, nor do they prescribe or perform medical treatment.

I understand that I am fully responsible for how I act upon and discern any insight or guidance that I am given. No legal or medical advice will be given.

I understand that it is recommended that I also consult a licensed physician or health care professional for any physical or psychological ailment I may be experiencing at any time.

I understand that all session rates include consultation, energy work and/or coaching. 100% of session fee is due upon scheduling for the first appointment.

I understand that No Show or cancellation of any future appointment is subject to owing 50% of total fee for missed appointment before rescheduling.

I understand that energy work and coaching is not a guaranteed one-time fix for any issue I may be experiencing. Multiple sessions are often advised.

Signature

Date

Check out my interview on Goldylocks Productions on my About Me page or on Youtube

Please complete the appropriate intake form for the session you are looking to schedule.
Have questions? Contact me here!

Human Client Intake Form

Animal Client Intake Form

Check out my interview on Goldylocks Productions on my About Me page or on Youtube

Please complete the appropriate intake form for the session you are looking to schedule. Have questions? Contact me here!

Human Client Intake Form

Animal Client Intake Form

Please complete the appropriate intake form for the session you are looking to schedule.
Have questions? Contact me here!