A PDF of your completed form will be sent to the email address you provide below.

Be sure to include a picture of yourself that has been taken in the last 24 hours so Gary can do your pre-session energy scans. Please include your first name in the file name. The image must be in either a JPG, PNG or PDF file format and the file size must be smaller than 8 MB. There will be a place to submit this file at the end of this form. It might be easiest to have this picture file prepared before beginning to fill out the Session Follow-Up Form.

Session Follow-Up Form

Please complete and submit this form 24 hours in advance of your next session. All boxes need to be filled out in order to submit the form. (ALL INFORMATION IS STRICTLY CONFIDENTIAL)

"*" indicates required fields

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Today's Date*
Name*
Email*
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PICTURE UPLOAD

Accepted file types: jpg, png, pdf, Max. file size: 8 MB.
This field is for validation purposes and should be left unchanged.