Client Forms

Please complete the 2 forms below
1 – Client Intake
2 – Informed Consent

Client Intake

Name

Email Address

Phone

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

What are your goals for this healing?

Do you have any of the following?

Heart ProblemsPacemakerChronic PainCancerMSLife Threatening IllnessChronic DiseasesLymphatic Issues

Do you have any pain?

yesno

If you do have pain where and what kind of pain?

Would you like me to help with that pain?

yesno

Do you have any diseases you would like me to address in this healing?

yesno

If yes, where and what disease?

Name

Date

Signature

Start signing your signature here

Informed Consent

Name

Email Address

ADULT CONSENT

I acknowledge that any healing that may take place as a result of Energy Healing or clearing sessions performed by Rev. Claudia Dale is strictly a happy by-product of Universal Energies or God's Energies. These sessions which may include the use of crystals, and intuitive counseling and should be used as a compliment to other therapies, not as a replacement for medical or Psychological care.

MINOR CONSENT

I, the parent/guardian of the child named below, give Rev. Claudia Dale of Your Soul’s Content permission to work with my child with the same intent and acknowledgment as in the above paragraph. I also acknowledge that I may be present at any and all times during these sessions if I choose to be.

Childs Name if applicable

Date

Signature

Start signing your signature here

Please note that any information or communication or consultation with Rev. Claudia Dale is for educational, spiritual and entertainment purposes only. Rev. Claudia accepts no liability and/or responsibility for any actions and/or decisions any client chooses to take based on his/her sessions with Rev. Claudia Dale.