Session form

Welcome. This session form is a requirement for any Theta Healing® session, reading, coaching package etc. Your session will be easier for you when you set your intention for what you wish to accomplish.
Your information is kept private, confidential, respected and never shared unless required by law.

Please become familiar with muscle testing and make sure you are fully hydrated before your session.
We may use muscle testing to find your root beliefs during a session.

Session form

* Indicates required field

What type of session have you booked? *

Location of session, ie. Skype session *

First AND Last Name *

Email *

Date of Birth *

Address *

City or State *

County *

Postcode or zip *

Country *

Contact land line phone number *

Contact Mobile/cell phone number *

Contact (in case of an emergency) *

List your goals and challenges in order of importance *

Are you being treated by a doctor? *

Are you diagnosed with any medical condition, mental or physical? If yes please state the condition *

List any medications you are taking, including supplements, herbs, remedies, vitamins etc. *

Any special needs we should know about? *

How you did you hear about us? *

Do you agree to our terms and conditions? If so type 'yes' (see terms and conditions page link at the end of this page) *

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All of our Theta Healing® Certified Practitioner Courses are approved and accredited by Vianna Stibal’s Theta Healing® Institute of Knowledge. Theta Healing® “®/TM: Trademarks .”

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The statements and testimonials found in this website are not intended to treat, diagnose, cure or prevent any disease. This information is given for educational purposes. In no way should any information on this website be considered as a substitute for care by your medical doctor or other healthcare professional.

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Session Form

Session form

​All of our Theta Healing® Certified Practitioner Courses are approved and accredited by Vianna Stibal’s Theta Healing® Institute of Knowledge. Theta Healing® “®/TM: Trademarks .”

All of our Theta Healing® Certified Practitioner Courses are approved and accredited by Vianna Stibal’s Theta Healing® Institute of Knowledge. Theta Healing® “®/TM: Trademarks .”