CLIENT FORMS

If you are a new client, you may download one of the following Questionnaires to fill out and return a minimum of 24 hours prior to your first session.  (Instructions below.)

This document is for new clients for EFT, healing, and coaching.

This document is for new clients for EFT, etc, AND also includes food and other sensitivities and allergies.

Once you have been accepted as a Client of Dr. Constance Wells, please fill out one of the Questionnaires above (you will be instructed which Questionnaire is most appropriate). The Questionnaire is rather lengthy and asks a whole lot about your health information. You only need to fill out what you think is pertinent.  Please feel free to leave blanks for those questions which don't seem to be relevant to your issue(s).  It would be very helpful if you returned the questionnaire at least a day BEFORE your first session, so that session time is not taken to review it. 

 

Download the file to your desktop (double click on the document image above); fill it out by double clicking in the Text Boxes, and save it when you are done.  The boxes can be expanded or shortened. Then, open up the email you received from Dr. Constance Wells, click REPLY to this email, insert the saved Questionnaire back into the e-mail.  If you don't drag it to your desktop first, it may not save your answers.  If that is too cumbersome, just print it out, hand write it, scan it, and email the scan.  If you would rather, you can mail it to the address listed below -- to be received at least 24 hours before your appointment. 

 

Please note that Dr. Wells does not process credit card payments.  Checks, money orders, or cash are all fine!  PayPal payments are also an option.  The first session fee is $175. Please allow an hour and 15 minutes for the first session. Thereafter, the session fee is $150 per 50 minute session (which usually ends up being close to a full hour).

 

Please let us know if you have any difficulties downloading or uploading the Questionnaire.  Thank you.

 

2331 Honolulu Avenue, Suite G, Montrose, CA 91020 ​©2005 Integrated Therapy Center.

 

Integrated Therapy Center - An Integrative and Holistic Approach to Healing Body, Mind, and Soul