New Client Form

I’m so looking forward to connecting with you! Please fill out this form to best of your ability at least 24 hours prior to our first session.

If you signed up for my Sacred Mattressence container, please note we will be going over your birth story and any challenges you’ve had in pre- or post-partum together live.

Name

First Name

Last Name

Email

Referred By

First Name

Last Name

How Old Are You?

Please Write Out Your Story As Pertains To What You're Working Through (if you feel called)

Please List Any Areas Where You Feel Stuck, Blocked, or Limited

Please Briefly Describe Any Traumas, Health Issues, Hospitalizations, Accidents, Allergies, or Current Medications

Have You Ever Been Diagnosed with Any Mental Health Issues?

What Is Your Heart's Desire As A Result of Our Work Together?

I understand that I will be participating in shamanic healing work. This is not a medical treatment nor is the information provided during sessions intended to treat, diagnose, cure, or prescribe. I agree to hold Emi Navas harmless for any reactions that may result from our work together. I understand that Emi Navas is not licensed for massage or medical treatment. I understand that it is always recommended to check with my physician before this or any healing work. I understand that if at any point I am going to harm myself or my baby it is my responsibility to call my doctor or emergency services immediately. I release Emi Navas from any liability related to my or my baby's health. Understanding the above, I give my permission for this healing work. Electronic Signature:

First Name

Last Name

New Client Form

Welcome home to the Sacred Woman you are.

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