Enter today's date

-- mm/dd/yy

Name

Address (include city, state, zip)

Contact information:

Work Phone
Home Phone
Cell Phone
E-mail
Website

II. Personal Information

Your birthday:

Children (names and ages)

Pets (types, names, ages)

Education

Previous Occupation

Current Occupation

General Health

Do you practice yoga?  How long?  Where?  Home Practice?

Which would you say you are most in touch with -- Mind, Body,
Spirit or Emotions?  How so?

How do you spend quality time with your spouse and children?

How do you spend quality time with your friends?

Do you receive body work?

massage     reflexology     acupuncture     other (describe below)

When is the last time you had a vacation?  How did you spend it?

Describe how your life is in balance or out of balance.

Which best describes your punctuality?

Always on time Frequently on time Seldom on time Never on time

Have you worked with a counselor/therapist?

Yes
No

What best describes your learning style? 
(Click on the link provided for each learning style to learn more.  Then
click on your browsers BACK button.)

Visual
Auditory
Tactile/Kinesthetic

Personality Type/Myers-Briggs

Favorite Color

Favorite Flower

Favorite TV Program

Favorite Sports Team

Favorite Candy/Sweet/Food

Favorite Type of Music/Artist

Favorite Vacation Spot/Location

Favorite Charity

Hobbies/Sports your enjoy/play

What do you do for fun?

If you like to read, what type of books/authors?

Do you have a best friend?

What's the most thoughtful and/or appreciated gift you've ever received?

How do you treat yourself special?

What sort of stores do you enjoy getting gift certificates to?

What do you enjoy collecting?

What's your idea of the perfect mini-vacation?

You know you're loved when . . .