LFT
Life Field Therapy
Life Coaching Hypnotherapy Mindfulness

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...Life is Magical Journey!

Before booking for the first time:

1.Complete Client Intake Form below

2. Read what is LFT Session

LFT Session - Client Intake Form

Please fill out the following form to help us understand your condition.

All personal information on this form is held securely, will be treated as strictly confidential, and is only for the purpose of making LFT treatment the best possible.

First Name

Date of Birth

Martial Status

Skype ID

Phone

Last Name

Ocupation

Address

Email Address

Emergency Contact

Choose which LFT Session you have booked

LFT Life Coaching

NLP Hypnotherapy

Spiritual Journey

Healing Codes

Pulsing

What is the problem you want to solve or heal? Describe.

What do you expect to achieve as the outcome of LFT Session?

Did you try to solve or to heal that problem on your own or by attending other specialist/therapy/other?

Yes

If YES – please describe in a few words what therapy/modality/other you have tried, to solve or to heal that problem and what was the outcome.

Are you undergoing some other life coaching, psychotherapy, hypnotherapy or healing right now?

Yes

If YES – describe what modality, what is the outcome?

Are you under medical treatment which uses drugs or medication which affects your state of mind, neurological/emotional state, or physical state?

Yes

If YES – describe. It is important to list all current medicines being used.

Do you have any experience with relaxation, meditation practices, breathwork or hypnosis?

Yes

If YES – describe what kind of practice, how long have you been practicing, what is your outcome.

If you are experiencing physical pain, please indicate which part of the body is in pain.

If you are in pain right now, please state when that pain started and what do you think was the cause.

If you are in pain right now, please specify from “0” to “10” – how intense is that pain right now.

Do you confirm that all those personal information included in that form are 100% genuine and the answers provided are nothing but the truth?

LFT Life Field Therapy Life Coaching Hypnotherapy Mindfulness