IC Intake Form (for self) | Lifeforce Integrated

Pranic Healing Energy Therapy Intake Form (for self)

This form is strictly confidential and for internal use only, unless disclosure is required by law.

Your full name

Your Phone Number: (This number will be added to a dedicated WhatsApp group for this specific Pranic Healing package.)

Your email: (This must match the email linked to your account profile. All communications from us will be sent to this address. You can update it anytime in the My Account section of our website.)

Address

Country of residence

Age

Gender

Alternate phone number (We'll use this only if we are unable to communicate via the primary number)

Emergency contact information

Full name

Phone number

Relationship with you