Emotionally Free - Clear Emotional & Health Issues with EFT
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EFT Procedure Demo for Clients
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New Client Form
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Russian-speaking clients
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Emotionally Free Home
Quit Smoking!
Fear of Public Speaking
What is EFT (Emotional Freedom Tecniques)?
EFT Procedure Demo for Clients
Scientific Research into EFT
EFT in the Press
Our Practitioners
Advantages of working with an EFT Practitioner
Pricing & Payments
Frequently Asked Questions (FAQ)
Client Testimonials
Book a session
New Client Form
Blog
Forum
Client Feedback Form
Russian-speaking clients
Legal Disclaimer
Privacy Policy
Locations & Working Hours
Contact Us
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YOUR CART
Emotionally Free Client Form
We ask all our new clients to fill out a New Client Form for several reasons. One, we need this for administrative and legal purposes. Two, we would like both you and us to be as prepared as possible before you come to see us, so that we can spend less time getting ready and as much precious time as we can during the session doing the clearing and coaching work. This way you can get the most benefit out of our sessions together. Please fill this out at least two hours before coming to see us.
Contact details
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Indicates required field
Name
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First
Last
If under 18, name of parent / guardian
*
Email address
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Skype user name
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Fill this in if you would like to have your sessions over Skype.
Preferred phone number
*
LivingSocial Redemption Number
*
If you have a LivingSocial voucher, please enter the Redemption number in this field so that we can validate it.
Address
*
Line 1
Line 2
City
State
Zip Code
Country
How did you find out about us and our services?
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About you
Date of birth
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Gender
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Male
Female
Unspecified / Transgender
Do you have any current health concerns?
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Yes
No
Please tell us about your health
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Please list your current medical concerns and major health issues from the past, any operations you have had, any medications, remedies or supplements you take and for what condition or illness do you take them?
Are you presently, or have been under the treatment or a Psychiatrist, Psychologist or Doctor?
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Yes
No
If yes, please list name of health care practitioner and describe
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What are you spiritual / religious beliefs if any?
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We respect your beliefs and want to stay clear of any topics that might cause offense.
Goals / Outcomes / Reasons for working with us
Please describe what you would like to gain from our work together
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What emotions would you like to address? e.g. anger, resentment, fear, sadness, hurts, grief, guilt, jealousy, loss, disappointment, stress or other.
Desired Outcome / Goal (1)
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How I feel without it (1)
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Related emotions (1)
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How I will feel when I have it (1)
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Desired Outcome / Goal (2)
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How I feel without it (2)
*
Related emotions (2)
*
How I will feel when I have it (2)
*
Desired Outcome / Goal (3)
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How I feel without it (3)
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Related emotions (3)
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How I will feel when I have it (3)
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Summary of significant / formative events
Ages 0-7 (Imprint period)
*
Ages 8-14 (Modelling period)
*
Ages 15-21 (Socialising period)
*
Other comments
Is there anything else you would like us to know?
*
Submit