Intake Form

All personal information is confidential and treated appropriately.

Do you have any physical challenges that would interfere with muscle testing? (e.g.: back/neck/arm pain or injuries)

Have you viewed the Rob Williams Psych-K video?

PSYCH-K® Preparation — The two fundamental questions that we ask in PSYCH-K are “how are things for me now?” and “how would I like them to be instead?” The answers to these questions can really illuminate areas in your life where your desires do not match your experience, and the underlying beliefs as to why this may be the case. PSYCH-K is used to modify sub-conscious beliefs from limiting ones to enhancing ones. It allows us to take back control of the part of the mind which is controlling 95% of our lives. Below is a list of common areas of life where people can have issues. Please select which areas you may need help with.

I understand and agree that I am individually responsible for my own life and it’s unfolding. As an expression of my responsibility I am seeking assistance with the beliefs that manifest my reality, but the actual manifestation of that reality is up to me.