Pre-Session Form for Dr. Michael Smith
Questions marked by * are required.
1. Full Name *
2. Email: *
3. Phone Number: *
4. Is the above number a cell phone and can I text you if something arises? (Very Very rarely, I might be a few minutes late).
  • Yes
  • No
5. Location (city, state, country). *
6. List numerically all of your biggest fears (as many as you can think of). *
7. List numerically your top DESIRES and wishes for your life that you want to manifest *
8. Please tell me a little about what you are seeking, and anything else that is important about your experience that is relevant for me to know? *
9. On a scale of 1(low) to 10 (high), how do you currently feel emotionally?
10. On a scale of 1(low) to 10 (high), how do you currently feel mentally?
11. On a scale of 1(low) to 10 (high), how do you currently feel spiritually?
12. Do you already own the Complete Empath Toolkit?
  • Yes
  • No
13. If you first found out about my work through a recommendation, whom can I thank?
14. Please type the following into the box: "I am 100 percent committed to my own success." *
15. Please check the box: *
  • Because of my own committment, I acknowledge that there are No refunds.