Client Intake Form

Long Distance Healing Session via Zoom
Return Client Form

Thank you for choosing to have a Long Distance Healing Session via Zoom with Colleáyn Klaibourne.
This Form is for Returning Client Healing Sessions with Colleayn

If you haven’t had a Healing Session with Colleayn before,
fill out this form so I can get your birth information.

* Each family member needs to fill out a separate intake form.
These sessions are done via Zoom.
Information to send to Colleáyn at least 4 Days before your session: 

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.


Thank you.