Discovery Form Name * First Name Last Name Date of Birth * MM DD YYYY Phone * (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country What is / are the issue(s) you would like to work on? If any, what other treatments or therapies have you been using so far for this / these issue(s)? When did you start having this / these issue(s)? What was happening in your life at the time? If there an emotional contributor to the issue(s), what would it be? Can you identify a pattern? I there were one event in your past that you'd rather leave out if you had to relive your life, what would it be? Thank your completing your pre session discovery form. I am looking forward to working with you.Susie x
