Disclaimer & terms of service

The more information you provide, the more prepared I will be and the better I can serve you. If you have any questions at all please feel welcome to call and clarify prior to submitting this form.

Evie's direct number: +61 412 005 357

Full name (including minors)

Postal address (if different from residential)

Religious or spiritual orientation

Emergency contact's number

If your contact person does not live close to you, please nominate a person below who does. This support person may be used as a secondary emergency contact.

Support person

Support person's contact number

Personal circumstances:

Please tick if you have a history of

Further detail (if required)

Are you feeling suicidal? Or have in the past?

If so, when and / or why?

Please list any medications or other substances that may affect you mentally or emotionally?

Are you involved in any legal proceedings wherein you may be required to testify? (If this changes during the course of our relationship it is important to advise immediately.)

Level of experience in EFT (tick all the boxes that describe your experience).

Let's get down to business.

Tick the issues that are currently most pressing to you.

Of the selected, which takes priority?

List any other strategies used to address this issue in the past.

When feeling "centred" or "good," what three emotions does that feel like? (e.g. peaceful, excited, energised, strong, confident, loving, etc.)

Is there anything else you want to tell me?

How did you find out about Evie?

For legal guardians of minors only: (minors are those under 18 years of age)

Full name of parents or legal guardians of minors:

Verification process on submitting this form

Client Intake Form