Do you have your first session coming up with Christy? If so, copy and paste the following questions, your answers and the waiver at the bottom of this page to firstname.lastname@example.org. Thank you.
Birthdate and age:
Would you like to receive my inspiration & wellness e-letter? yes or no
How did you find me?
What is your main reason for coming for a session?
Please describe any other symptoms and how long they have been happening:
(These could be physical, emotional, mental, spiritual, financial or aspects of life such as
letting go, trauma, self worth, growing pains as you evolve and transform)
Do you smoke? If you quit, how long ago?
Please list medications, herbs (legal or illegal), supplements:
Other health care practitioners you currently see and why:
Briefly describe your medical history including traumas, accidents, surgeries, illnesses:
Please describe your living situation (alone, or people and animals you live with):
How are your stress levels relating to health, family, relationships, finances, work, life purpose, self worth?
Please describe length and quality of sleep:
What do you do to relax?
What you do for exercise and how often:
Hobbies and dreams for your life:
What inspires you?
1. Do you menstruate?
2. If so, how is your ovulation, PMS and moon cyle?
3. Are you pregnant? If so, how far along.
4. How many previous pregnancies?
5. Do you have children? If so, what age?
6. Other related information to your reproductive heath:
• • •
Is there any other information that you would like to share that could be relevant to your session?
I__(type full name here)___understand that Christy Dawn Lindell Greenwood intends to provide a confidential & high quality session to enhance relaxation, encourage the body’s own innate intelligence to reestablish communication with itself, and to educate around possible energetic or emotional blocks that many create pain and dis-ease. She does not take responsibility for any adverse reactions resulting from treatments. I understand that BodyTalk or other holistic therapies do not substitute for medical treatment or medications. Please consult your Naturopath, Chinese Medical Doctor, Western Medical Doctor or other qualified medical professionals for persistent pains or symptoms. I am aware that Christy Lindell Greenwood does not diagnose illness or disease nor does she prescribe medications.
Sending this email to email@example.com indicates that you have read the waiver and have given all relevant & accurate information about your health so your session many be customized for your safety and wellness. Thank you.