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.