Pre-Session Form for Dr. Michael Smith
Questions marked by * are required.
1.	Full Name *
2.	Email: *
3.	Re-enter email for accuracy *
4.	Phone Number: *
5.	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
6.	Location (city, state) & TIMEZONE. If outside the US, don't worry about timezone. *
7.	List numerically all of your biggest fears (as many as you can think of). We will work with these. *
8.	List numerically your top DESIRES and wishes for your life that you want to manifest *
9.	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? *
10.	On a scale of 1(low) to 10 (high), how do you currently feel emotionally? We will use these questions to track your progress.
11.	On a scale of 1(low) to 10 (high), how do you currently feel mentally?
12.	On a scale of 1(low) to 10 (high), how do you currently feel spiritually?
13.	Do you already own the Complete Empath Toolkit? Yes No
14.	Please upload a small picture of yourself (this helps Michael tune in to your energy).(optional)
15.	Please type the following into the box: "I am 100 Percent Committed to my own success and changing my life." *
16.	Please check the box: * Because of my own committment, I acknowledge that there are No refunds.