Remote & In-person 1:1 session Intake Form for adults, children, and petsPlease complete this form after you placed your order. Your Name * First Name Last Name Your Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Cell Phone * Country (###) ### #### Who is receiving this session? * If it is not you, please write the name of the recipient and relationship with you. If this is for your pet, what kind of animal is your pet? Recipient's Date of Birth MM DD YYYY If date of birth is unknown, what's the current approximate age? List up to 3 goals or areas you would like to improve * Prioritize physical, emotional or mental aspects over other areas. Any medications or treatment you are currently on? On a scale of 1 to 5 (1 = mild, 5 = most severe/urgent), how would you rate the severity? * * 1 2 3 4 5 In-person or Remote? * In-person Remote Remote session options How would you like to receive this session? If you select more than one box, Tomoko will choose what feels best. Offline Zoom Phone call Scheduling for remote session If you selected Zoom or phone call option, please list three times that work for you. Tomoko is available between 9am-6pm pacific time Monday through Saturday. Please complete the Disclaimer, Terms and Conditions Agreement linked in the next page after you click "SEND". * All clients are asked to submit this form once including new and returning clients. Yes, I understand. Please click the link below to complete the form prior to your session. All clients including existing clients are asked to submit this updated form once.Disclaimer, Terms and Conditions Agreement Tomoko will be in contact with you shortly. If you don’t hear anything for more than 48 hours, please email info@flowinginlight.com.Thank you and see you soon!