New Client Form Describe Your Present State - How You See your Life Currently Describe Your Desired State (How You Would Truly Like It To Be) Describe The Blocks To Your Desired State (What's Stopping You) Describe What You Value In Life (Eg Family, Health) What Do You Do For Fun Health Conditions First Name Last Name Next of Kin (First & Last Name) Occupation Address Suburb Mobile Email Gender Male Female Prefer Not To Say Age Name of person who referred you (First and Last Name) Preferred Session Day (You need to choose at least one day but you can select more than one if you want to we just can’t give you a guarantee! MondayTuesdayThursdayFridaySaturday New Vibe Energetics reserves the right to charge a FULL fee where a client unreasonably cancels their appointment once it has already been confirmed. Acceptance I accept that if I cancel my appointment after I have already confirmed my attendance that that I may be charged the FULL amount as a cancellation fee. I also agree to pay a $50 deposit to be paid for my first appointment (once off). This can be paid by PayPal of EFT on the following page or when my appointment has been arranged by Reception. Send
