New Client Questionnaire

Please fill out the following form to help me understand your current condition. This is a requirement prior to your first session.

First Name

Address

State

Zip

Email Address

Last Name

City

Phone

Date of Birth

How can I help you?

Are you currently suffering from any medical condition? If yes, please explain.

How would you like to be contacted?

Phone

Zoom Call

I understand that Tricia and SoulSource Healing make no promises with regard to a healing.*

I declare that the information I’ve provided is accurate & complete.*

Your Signature

Today's Date

I accept terms & conditions

Thank You!

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MEDICAL DISCLAIMER:
Tricia Dewar is not a licensed medical doctor, chiropractor, physician or other formally licensed healthcare professional. Therefore, Tricia does not render medical, psychological, or other professional advice or treatment, nor does she provide or prescribe any medical diagnosis, treatment, medication, or remedy. Nothing in this website should be construed to constitute healthcare advice or medical diagnosis, treatment or prescribing. Tricia encourages you to seek the care of a licensed healthcare professional if you believe such care is required. Information or guidance provided by Tricia should not be construed as a promise of benefits, a claim of cure, or a guarantee of results to be achieved. Tricia makes no guarantees or warranties related to her service.

Royal Oak, Michigan 1-248-385-2539