Please complete and return the Intake Form before your appointment.

If you have any questions, call me 214-499-2783   deb.comp.sol@sbcglobal.net

Name *
Name
Address
Address
Mobile
Mobile
Home
Home
Religious/Spiritual Affiliation/Beliefs
Marital Status
Number of Children
Give one sentence that best describes the relationship with your parents
Do you have any physical challenges that would interfere with muscle testing?
Briefly explain.
Other techniques or therapies you have participated in.
GOALS... What are the top 3 things you would like to address?
Other... What is missing from your life?
What would make your life more fulfilling?
In your opinion, what accomplishments must occur during your lifetime so that you will consider our life to have been satisfying and well lived - a life of few or no regret?