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Healing Session Client Intake Form

Healing Session Client Intake Form

Thank you for choosing to have an Qigong Healing with Colleáyn Klaibourne.
Each family member needs a separate intake form.


Information to send to Colleáyn at least 48 hours before your session: 

  1. This Client Intake Form.  *All fields are required.
  2. Photograph(s): Email or send Colleayn a clear, recent photograph(s) (within a year or so) with at least one with your eyes towards the camera.  (That is how I tune into you.)
  3. Payment (Pay via website, send check in mail before session date, or Colleáyn will email you a PayPal invoice.)

I look forward to working with you.


Client Intake Form

The reason I ask for occupation is in case I'm seeing different work, hobbies, education, etc. that would be good for you to explore.
This information will not be sold or abused in any way.