Personal Health Assessment

Please complete and send in your form at least two days prior to your session.
It should take you about 10 to 15 minutes to fill out this form. It is easier on a computer as opposed to a mobile device.

I look forward to working with you.

It is my choice to receive holistic life coaching/energy therapy sessions with Donna Burick. I understand that this is not a substitute for medical treatment or medications. I am aware that Donna does not diagnose illness or disease nor did she prescribe medicine. I understand that my participation in these sessions is voluntary and that at any time I may choose to end my participation. I acknowledge my responsibility for exercising my judgment and initiative and choosing to receive these sessions. I also acknowledge that all information given to Donna Burick is 100% confidential.

Sessions must be canceled 24-hours in advance to avoid paying for your scheduled session.

By this consent, I knowingly and voluntarily assume responsibility for my healing process.
Please Note: 24-hour cancellation notice required.
Sessions must be canceled 24-hours in advance to avoid paying for your scheduled session.
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