SCHH®​ Client Intake Form

We appreciate you taking the time to review this information, complete the enclosed form and supply us with the items requested below. Please fill out this New Client Assessment form prior to your appointment at least 5 days in advance. If the form is received the day of our meeting, we may need to spend time reviewing it, which takes time away from your healing session. Your healing sessions will consist of a quick introduction before we start and a wrap-up afterwards.


Health Profile

Areas of Concern

In this section, list your main issues and rate them by severity on a scale of 1-10, with 10 being the most severe. *Please note that we will address as many issues as possible, but it’s often best to deal with fewer at a time. This is why booking multiple sessions is important.

Medical History

Please answer the following questions in confidence.

Emotional Checklist

Do you have a problem with any of the following?

Questions for your Higher Self