Pre-Session Form for Dr. Michael Smith
Questions marked by * are required.
1.	Full Name *
2.	Email: *
3.	Cell Phone Number (if you don't have a cell phone leave this blank). I will only use this to text you if something important arises. *
4.	Location (city, state, country). *
5.	List your top two or three biggest fears: *
6.	List your top DESIRES and wishes for what you want to manifest: *
7.	Please tell me a little about what you are seeking, and anything else that is important about your experience that is relevant for me to know? *
8.	Date of Birth (Month-Day-Year) (This info, like all on this form, is confidential).
9.	Enter your Sun, Moon, & Rising astrology signs (if you know them):
10.	On a scale of 1(low) to 10 (high), how do you currently feel emotionally?
11.	On a scale of 1(low) to 10 (high), how do you currently feel mentally?
12.	Do you already own the Complete Empath Toolkit? Yes No
13.	How did you FIRST find out about my work? (Google, Facebook, Webinar or Summit, Recommendation, other): *
14.	If you first found out about my work through a recommendation, whom can I thank?
15.	How can I best serve or help you? Tell me in your own words what you envision my role to be:
16.	What's your predominant sense or style of learning? Visual, auditory, FEELING, etc? If you don't know, that's totally okay.
17.	Please check the box: * Because of my own commitment, I acknowledge that there are No refunds. I also acknowledge that all sessions expire 4 months after purchase and must be used within that time. This form is secure despite any warnings your browser may give. (I have used it for 10 years with no issues).