Michael Golzmane's Client Intake Questionnaire

Hello, my friend!  The following form is designed for me to get to know you a bit better--a bit of your background, experience, and perspective when it comes to your healing process.

This form will also give me relevant information for our healing work together.

I ask you to just take a moment now and center yourself.  Take a few deep breaths and perhaps ask your High Self to help you be honest and open in communicating the desires of your heart through this form.

I very much appreciate your input, and I so look forward to our work together!

Peace and Abundant Blessings,
---Michael Golzmane

Phone Number: (in the USA): (845) 481-2221
Email:  michael@clearandconnect.com

Name *
Your Date of Birth
Your Date of Birth
Your Mailing Address
Your Mailing Address
Your gender *
Have you experienced energy healing/clearing before? *
Have you experienced distant energy healing before--where the practitioner is not physically present with you during the session? *
By requesting this healing session, are you willing to give Spirit and Michael conscious permission to work within your energy field, to do this clearing and healing? *
This could include prayer, meditation, dancing, energy healing work, yoga, qi gong, chanting, reading spiritual literature, etc.
Do you have a certain religious affiliation? Are you a "new ager"? Do you consider yourself "spiritual"?
Are you ready and willing to do whatever it takes to be well? *