Discovery Form - Tap Into Your Best Self

Tap Into Your Best Self Online Discovery Form

Name

Address

City

State

Zip Code

Country

Cell Phone

Emergency Contact - name and phone number

Date of Birth

Gender

Occupation

What has brought you to tapping?

How long has this issue been going on?

What was happening in your life when this began?

Anything else you would like to share with me?

What would you like to improve or change in your life?

Describe how your life would be without this issue and how you would feel?

What is the best thing currently in your life?

What do you like to do for pleasure?

How committed are you to making changes during our sessions?

What do you expect from our sessions?