Client Intake Form

Healing Session

Thank you for choosing to have a Healing Session with Colleáyn Klaibourne.
* Each family member needs to fill out a separate intake form.
These sessions are done via Email.
Information to send to Colleáyn at least 48 hours before your session: 
  1. This Client Intake Form. * All fields are required.
  2. Photograph(s): Email or send Colleayn a clear, recent photograph(s) (within a year or so) with at least one with your eyes facing towards the camera. This is how I tune into you.
  3. Payment. Pay via website or Colleayn can email you a PayPal invoice. If you are a return clients and prefer to send a check before the session, email Colleayn for the address.

I look forward to working with you.

Client Intake Form

Each field needs to be filled out completely in order for this form
to be successfully submitted to Colleayn.
The reason I ask for occupation is in case I’m seeing different work, hobbies, education, etc. that would be good for you to explore.

Questions for your Session

This will give me an idea of your topic of interest and questions before your session so I can prepare and analyze your charts ahead of time. We will see how much we can cover during our session together because no matter how much time we have together, it never feels like enough!
What are your goals or what do you hope to receive from your session? The more information you share, the deeper I can look at what is happening.
Information for if you are having a consultation with Qigong healing.
This is for your healing session and see the big picture of things.
For example: Dates of when you got sick or injured, dates met with specialists or received a diagnosis, tests, surgery dates. (Knee surgery, 9/14/23 at 8:00 am in Rochester, MN.)
For individuals who are having healing sessions before, during and after surgery.

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Birth Information for Astrology Chart. *Required for Zoom Healing Sessions*

Please include your birth location, exact time of birth and if you were born in the am or pm.
Please write out the month. For example: January 1, 1999 or March 2, 2011.
Exact birth time is required in order to create an accurate astrology chart.
Ex. Birth Certificate (Hospital Record, Birth Record), Parental Memory, Baby book, Rectification from another Astrologer….

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Thank you.

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