Client Intake

Please fill out the following form
for further assistant

First Name

Last Name

Email

Date of Birth

What type of Healing modality ar you interested?

Myofascial Release

B.E.S.T

Energy Healing

Medical Intuition

Are you taking medication?

No

Yes

Are you suffering from a medical condition, illness, or injury?

No

Yes

If you answered yes to any question, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

"Awareness is the first step toward healing"- Dr. Dean Hornes.

INFINITY HEALING STUDIO

Infinity Healing Holistic Wellness Studio offers Manual Lymphatic Drainage, Post Surgery, Oncology, Post Mastectomy, Geriatric, Myofascial Release, CranioSacral Therapy Massage & Bio-Energy Synchronization Technique Therapy in Las Vegas, NV.

Clark County Business License 2008871-062-101

City of Las Vegas Business License G71-01885

NVMT# 11520

ABMP Member & Insured.

EMPA Member & Insured.

S4OM Member.

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