New Client Form — Imani Nic

Here we go! 🚀

I am so excited to be working 1:1 with you. This is a form to get us started on our in depth journey together. Please answer these questions as thoroughly as you can. We will review this form in 3 months to see where we are at.

Name

First Name

Last Name

Phone

(###)

###

####

Please list the things that inspired you to make this investment in working together?

What health issues do you have and for how long have you had them?

Please be as specific as you can. Aches and pains included.

How would you most like to feel 3 months from now?

Please spend extra time on this part, really feeling into HOW you most want to feel.

How are your relationships with those in your life? Do any need to be healed?

Have you ever been in therapy or tried other therapeutic modalities? If yes, which ones and what was your experience?

If no, please skip.

How often do you experience sensations of anxiety?

Often

sometimes

rarely

never

What are you most excited to overcome or gain during our time working together?

Please provide your astrological information

Birth Date, Exact Time, Location (City, State, Country)

What professional industry are you in? Tell me how you feel about your career/work etc.

Please share any changes you would like to see in this area as well as financial goals you have + what you feel may be in the way of them.

What brings you joy? How much time do you spend doing these things?

Make a list. What do you LOVE to do?