New Client Intake Assessment Form

Must Be Completed And Submitted A Minimum Of

24 Hours Prior To Your First Appointment

Please be sure to click "Submit" at the end

Call TODAY! 920-412-9980

Success Is Waiting For You

Easy And Effective

Long Lasting Results

Make Your Appointment

​No Negative Side Effects

The "Submit" button will only be active once every question with a red star is answered. If not applicable to you then simply type in N/A

We operate in the interest of best efforts for all clients. The client understands that results may vary and are not guaranteed. We will employ multiple modes of emotional and spiritual healing as needed for the individual client and as assessed by our healing professionals. All sales are final and all contracts are valid. Our programs are designed to assist with the letting go of past unwanted issues and moving forward in life with a new positive outlook to achieve individual goals for the client.