ANTHONY LARKIN
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NDE Pod Cast
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QHHT
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ANGELIC REIKI
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Pre Appointment Screen
Pre Health Check for Reiki or QHHT Clients.
This Client Profile Questionnaire
MUST
be completed before your appointment.
Your information will be kept in the strictest of confidence and inline with the GDPR 2018.
*
Indicates required field
Name:
*
Mobile:
*
Email:
*
Please answer the questions truthfully and honestly by ticking the associated box.
If you tick a box, please leave comments in the free text field at the bottom of this page giving more information.
Tick boxes if answer is yes:
*
I have difficulty in conversing in the English language.
I suffer with hearing loss, or find it difficult to hear when people are speaking.
I have been diagnosed with schizophrenia or multiple personality disorder.
I am currently under medical supervision.
I have difficulty lying on my back.
I have allergies / sensitivity to incense sticks, oil burners or scented candles.
I am unable to climb up and down a flight of stairs independently.
I have read all of the above and I will disclose any information required in the box below. If nothing to disclose, please type in the word (NOTHING) and click Submit
Use this text box below to give me more information if you did not tick any of the boxes above.
(All of the information on this form or disclosed in your session is completely confidential)
Comment
*
Submit
Home
Meet Anthony
NDE Pod Cast
AUTHOR
QHHT
QHHT QUESTIONS
ANGELIC REIKI
Pricing & Booking
Reviews
Contact
Booking Policy
Pre Appointment Screen