Name Last Name Work Email Work Phone Number How do you heal your clients? BOTH In-Person and Online ONLY Online ONLY In-Person How long have you been pracitcing energy work? Under 1 year 1-3 years 3+ years How many clients have you served already? 0 clients 1-3 clients 3-10 clients 10+ clients What zipcode do you live in? If you have a website, please paste it in here or say N/A: Do you specialize in age? No Yes 10-18 Yes 18 - 30 Yes 30 - 55 Yes 55+ Do you specialize in a specific gender? No Yes - Women Yes - Men Yes - LGTBQ Do you focus on specific problems? No Yes - Anxiety Yes - Chemo Patients Yes - Pregnancies Yes - Chronic Fatigue Yes - Digestive Sensitivity Yes - Chronic Pain Yes - Other Why should someone heal with you and trust you? Please list any qualifications you may have: Please upload a profile picture of yourself Send
