Pre-Session Form for Dr. Michael Smith
Questions marked by * are required.
Full Name *
Re-enter email for accuracy *
Phone Number: *
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).
Location (city, state, country). *
List numerically all of your biggest fears (as many as you can think of). *
List numerically your top DESIRES and wishes for your life that you want to manifest *
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? *
On a scale of 1(low) to 10 (high), how do you currently feel emotionally?
On a scale of 1(low) to 10 (high), how do you currently feel mentally?
On a scale of 1(low) to 10 (high), how do you currently feel spiritually?
Do you already own the Complete Empath Toolkit?
OPTIONAL: Please upload a small picture of yourself (this helps Michael tune in to your energy).
Please type the following into the box: "I am 100 Percent Committed to my own success and changing my life." *
Please check the box: *
Because of my own committment, I acknowledge that there are No refunds.