NATURAL Centre Consciousness & Flourish

TREATMENT QUESTIONNAIRE:

To be able to serve you best we need some information. Please answer the questions below.

After answering these questions we ask you to send it to natuurlijkcbb@gmail.com (because of new European privacy rules it is important to notice that sending this information is your own responsability).
After reading your questionnaire we will answer you as soon as possible if we can help you with our NATURAL clairvoyant approach.
After that we can organize a session in our practice in Peize / Holland.
Or do a distant healing session together, we can have contact by phone then.

Privacy
We do our best to guarantee your privacy. All answers below are only meant to have clear information during our session together.

QUESTIONNAIRE:

Name:
Address:
Postal code:
City/village:
Country:
Telephone:
Email:

Man/Woman:
Date of birth:
Situation at home. Living alone, with a family, etc?:
Working situation?

Please answer these questions concise, keep it brief and to the point:

1a What is the reason you want a NATURAL session/treatment?
1b What would be a good result?
1c Are there physical and /or psychological complaints?
If yes, please give a short description:

2a Did you receive treatments by a physician/specialist/therapist lately?
If yes by whom and whatfor?
2b Do you use medicines?
If yes which ones, for what and for how long?
Prescribed by whom?

2c Did you undergo operations, did you stay in hospitals?
If yes, for what and when?:
2d Are you (woman) pregnant?:

3a Did you experience traumatic events? We mean experiences with a lot of impact, fierce emotions, major consequences, etc.
This could also be interventionist periods in your life.
If yes, please describe briefly:

4 Do you have remarks that could be important?

5 How did you find us?

Thank you! Please send your questionnare to natuurlijkcbb@gmail.com

Aafke Douma & Rob Heiligers

www.NATUURLIJKCentrumBewustzijnenBloei.nl