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About
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Healing Sessions
Nutrition
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“I want to be like a sunflower so that even on the darkest days
I will stand tall and find the sunlight.”

Healing Session Intake Form

Please complete as much of this as you are comfortable sharing. The more you share of this privately with me, the more beneficial our session will be to you.

Date

Name

Best phone

Mailing address

Relationship status

Please select your most pressing current Issues

Stress or Anxiety Fear or Phobias Weight Issues Empty Nest Menopause Anxiety over aging Divorce or Breakup Traumatic Memories Lack of Joy Workaholic Low Self-Esteem Chronic Pain Grief Lack of Purpose Anger or Resentment Lack of Confidence Performance Prosperity

Have you seen a therapist, coach, or other healer for any of the above issues, and if so, when?

What have you tried to solve these issues that has worked?" What has not?

Have you experienced EFT? With a practitioner or on your own?

Did you grow up with siblings? What was their birth order?

Is there a situation, issue, memory or physical problem you would like us to start with?

Who might be upset if you resolve your current challenge? (Who benefits from you having this challenge?)

What are three positive goals you would like to achieve?

How would you like to feel at the end of your session?

Is there anything else you'd like to share with me?

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Helping women heal and rebuild emotionally, physically, and financially after divorce.

All services provided by Christine Regan Lake are for educational and spiritual purposes only.

Home
About
Shop
Healing Sessions
Nutrition
Blog
Testimonials
Contact

Home
About
Shop
Healing Sessions
Nutrition
Blog
Testimonials
Contact

Let me give you my free top 10 tips for physical, spiritual, and financial renewal after divorce.

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