IC Intake Form (for another) | Lifeforce Integrated

Pranic Healing Energy Therapy Intake Form (on behalf of someone else)

Is the client a minor (under the legal age as defined by the laws of their state or country of residence)?

Yes

No

Please state your relationship with the client.

Will you be actively involved with Lifeforce Integrated on behalf of the client (providing updates and feedback, scheduling Touch Base meetings, etc.)?

Yes

No

Your Phone Number: (If you're actively involved with Lifeforce Integrated you may be added to a WhatsApp group exclusively dedicated to the Pranic Healing package.)

Your email: (This must match the one in your member profile to receive emails from us. You may log in and update it in the My Account section.)

Please state your full name

Your country of residence

Do you live with the client?

Yes

No

If you don't live with the client, are you able to visit or communicate with them? How often? Please elaborate.

Is the client willing to receive Pranic Healing energy therapy?

Yes

No

Other

If you selected 'Other', please elaborate.

Will you be the client's emergency contact?

Yes

No

Please click Next to start filling in the Client Details form.