(married, single, widowed, pets, children, roommate, stressful home, work from home, caregiver)

1=Minimal, 5=Moderate, 10=Extreme Select top 5 areas of concern from the list or add your own: Personal Relationships, Physical Health, Mental/Emotional Health, Work/Job, Finances, Eating Issues, Addiction, Depression, Mood Swings, Anger Issues, Anxiety, Panic Attacks, Emotional Trauma or PTSD, Memory Problems, Headaches, Back Pain, Fatigue, Allergies, Sleep Issues, Other list out below.

Please describe here

Nature, Church affiliation, Meditation, Other practices

Please provide a year and general description of what triggered it and how it was "fixed".

List below and for how long taking.

By providing the above information before your session and by reviewing this information about what Healing Touch is and what Crystal Healing is, you acknowledge and understand that this complementary energy based approach to health and well-being can assist your body in its natural ability to heal. There is no touching via this remote session and you promise to be located in a safe, quiet environment to receive the work. You understand that Healing Touch can include: *reduction in pain, anxiety and stress * supports the body's natural healing process * emotional, mental and spiritual support * prep for medical treatment or procedure With this above information provided in confidence and understand that Amy Stephens, HTCP is released from any claims or liability arising or in connection to your session(s).

who referred you, social media, on my email list

Healing Touch and Crystal Healing Form

New Client Session

Energy Session - New Client Form