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, country). *
7. List numerically all of your biggest fears (as many as you can think of). *
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?
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. OPTIONAL: Please upload a small picture of yourself (this helps Michael tune in to your energy).
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.