Testimonials of anxiety relief, stress reduction, powerful holistic healing by Jessica Lin, Maryland, Virginia, Washington DC

CONFIDENTIAL CLIENT INTAKE

Welcome to Jessica Lin Mind-Body Healing and Hypnosis. Please fill out this form carefully in order to make best use of our session time together. Information submitted is kept strictly confidential.

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Currently under a medical doctor's or a mental health professional's care for: *

Please describe your current challenges (physical, mental/emotional, or spiritual): *

List at least THREE goals you wish to achieve from the sessions: (Please be specific and number each item) *

How would life be different (and better) for you when you've reached the above three goals? (Please be specific) *

Describe one of your favorite scenes or places, which symbolize to you good feelings such as peace, harmony, tranquility, or relaxation. Be sure to focus on the senses, (e.g. pleasant scent, breeze, warmth of sunlight, etc.) evoked by the scene: *

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