New Client Form
Okay to text appointment reminders?
Legal Guardian if Under 18
Living Situation (marital status, number of children, pets, etc.)
How would you describe your current challenges?
What are your goals for yourself/child/family?
What are the strengths of you/your child/family?
Current physcial/emotional/mental concerns or issues:
To what do you attribute your current concern?
What does this situation being healed look like to you?
Thank you for the opportunity to serve you. Our goal at HeartLight is to build stronger families through education, consultation, and the use of other therapies, such as nutritional support and energy medicine, when needed. All sessions are confidential. Energy medicine can be done on or off the body, but is always practiced within your consent and boundaries and is non-sexual and gentle. Energy medicine is meant to compliment standard medical practice, not to replace it, and no guarantees as to the result of treatment are expressed or implied. Sessions start at $125.00 per hour, unless other arrangements have been made, and cancellation less than 24 hours before an appointment will result in a $50.00 fee being applied to your account. I understand the services at HeartLight are not a replacement for medical or psychiatric care, and that Sarah Green is not a mental health professional or therapist, and no diagnosis will be made. I understand that I am financially responsible for all services rendered.
By checking this box and typing my name above, I acknowledge and agree to the above conditions.