Registration Form for New Clients

Please fill out the following form

It will help me better understand your situation and tailor our work to what your system currently needs. You’re welcome to leave any fields blank if they don’t feel relevant right now.

Please note that I am not a medical doctor or psychologist. Resonance Repatterning, Biofield Testing, LebensTransfer and other healing modalities that I am offering are forms of energy work and not a substitute for medical or psychological treatment.

By submitting this form, you acknowledge that the purpose of each session is to support the release of energetic, emotional, or mental blockages and to activate new inner resources.

You understand that this work does not involve diagnosis or prescription, and that it is not intended to replace professional medical care.

"*" indicates required fields

Name (first name and last name)*

Email*

Address*

Mobile number*

Date of Birth (DD.MM.YYYY)*

Current age

Occupation

How did you find me?

Single / married / in a relationship

Are you religious or spiritual?

Do you meditate or practice any form of mindfulness?

Do you have other practitioners / coaches / etc. at the moment?

Do you have any diagnoses related to psychological or neurological conditions (e.g. psychosis, epilepsy)?

Do you have any chronic diseases? If so, since when?

Describe any hereditary illnesses you are aware of?

Do you take any medication?

What are your expectations towards this work?

What are your emotional and physical problems?

Since when do you have them, and what happened, when they first appeared?

Which difficult feelings did you have in the recent months?

e.g. sad, powerless, depressed

In which life areas do you have stress and how much stress (from 1 to 10, 10 being the highest stress factor)

e.g. family, relationships, finances, health, other

How are your family relationships and the quality of your relationships with them?

Do you have fears, anxieties or phobias?

What is your goal in your work with me?

What else did you try so far?

What is your vision for yourself after your transformation?

How willing are you to change (1-10; 10 being the most willing)?

Please confirm with “Yes” that you understand that I am not a doctor or psychologist. Resonance Repatterning, Biofield Testing, Life Transfer, and other healing methods I offer are forms of energy work and are not a substitute for medical or psychological treatment. By submitting this form, you confirm that the purpose of each session is to release energetic, emotional, or mental blockages and activate new inner resources. You understand that this work does not involve diagnosis, medical or psychological treatment, and is not intended to replace professional medical care.*

Place, Date*

Signature*

Please enter your full name; this will serve as your digital signature.