New Client Questionnaire - Living Voice Medicine

Welcome! Please fill out and submit the form below before scheduling your appointment. You may want to copy and save any long responses in case something happens to the form (which is rare). Fields with asterisks are required. In filling out the form you will be sent an e-mail invitation to sign up for my (infrequent) newsletter, which you can use to accept or ignore the invitation.

First Name *

Last Name *

Email Address *

Phone Number *

What pronouns should be used to refer to you?

she/herhe/himthey/themother - will explain in-session

What types of sessions are you interested in? *Ancestral Lineage HealingSpirit Healing

What is your current intention for sessions? *

What forms of healing work have you engaged in the past and what forms are you currently engaged in? *

What regions of the world are your ancestors from (if known)?

If you have already started Ancestral Lineage Healing, where are you at in the process? (e.g. I have completed two primary lineages and have been working on the third.)

Anything else you would like me to know?

Please write "I agree" in the box below if you agree with the following: Maris (legal name Melissa Rosenberger, agent of The Golden Lyre LLC) is not trained in mental health assessment and therefore you as the client will be responsible for your psychological well-being before, during, and after sessions. This form of work can catalyze significant change. You are responsible for managing the effects the work may have on your life including getting additional support from health care providers if necessary. *

This work is NOT for people with unstable mental health conditions or who are in crisis. As this work can catalyze significant change a certain amount of resiliency and self-sufficiency is required. If you are not in crisis and are in stable mental health please verify by writing "I qualify" in the box below. *

Please write "I agree" in the box below indicating you have read and agree to my Appointment Policy: In particular that 24 hour notice is required for cancellations and rescheduling, no refunds will be made for no-shows or same-day cancellations, and appointment duration will not be extended for late starts unless the lateness is on my end. Please contact me by e-mail if you will be late or are having technical difficulties. Payment for session is due 24 hours in advance and serves as confirmation for your appointment. *

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