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Intake Form

Please fill out the Intake Form and fill it out prior to purchasing a service.  Once we have this information we are better prepared to provide you with the answers and support you need. You can fill it out online or download the PDF to fill in and send it by email to shop@christine.doctor


Click here – Intake Form (PDF)


FILL OUT THE INTAKE FORM ONLINE

 

Click or drag a file to this area to upload.
How do you sense these symptoms, pain: pressure, pulsating, choking, pounding, cutting, etc. Please provide a good description if possible, with visualization and imaging as best as you can.
Examples: Movement, lie down, pressure, a temperature higher or lower than usual, storms, weather changes, water contact, specific time of the day, during sleep, seasonal, light or excessive sunshine, when eating, when excreting, when menstruating, nervous, stress, dispute, grief, anxiety, worries, full moon.