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.