THE PORTAL — The Shed 888

Let’s get to know you and what we are working on together

Welcome to your 6 week supercharged package. I am beyond excited to work with you. To ensure we get the most out of our sessions together please fill out the form below.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

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Date of Birth

Emergency Contact, Name, Number & Relationship to you?

Instagram Handle

Please set an intention for this session.

What specific challenges or areas of your life do you wish to focus on during this package?

Have you previously tried any holistic healing modalities or therapies? If so, please specify.

What specific goals or outcomes you hope to achieve by the end of this program?

How would you describe your current emotional and mental well-being?

What would you rate your stress levels as of reading this form?

What particular emotions or patterns you would like to address?

Are there any physical health concerns or conditions you would like me to be aware of before we begin?

Is there any other information or areas we need to be wary of when working together? Please specify.

Health Care Terms and Conditions:

- By acknowledging this form, you acknowledge that the services provided are not a substitute for professional medical or mental health care. - The information provided in this form will be kept confidential and used solely for the purpose of tailoring the healing program to your specific needs. - It is important to communicate openly and honestly throughout the duration of the program to ensure the most effective support and guidance. -The practitioner reserves the right to modify or adjust the program as needed to best support the client's well-being. Do you agree with these Health Care Terms and Conditions?

Yes

Other

Payment for the 3 month Tune Up package is due upon registration and is non-refundable.

Has a payment been made to Sarah Ross BSB: 0635 511 ACCOUNT 1032 3921

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