Client Feedback Form

for Joy Gardner's

VIBRATIONAL HEALING CERTIFICATION PROGRAM

Practitioner-In-Training __________________________________________________________________

Client ________________________________________________________________________________

Type of Treatment ______________________________________________________________________

Client's Phone Number(s)_______________________________ Email ____________________________

Dear Client: The practitioner-in-training who has given you this form will benefit greatly from your honest answers to the following questions. Ideally, please answer these questions within an hour of completing your session.

Why did you want a session? If you had any symptoms (physical, emotional, mental or spiritual), what were they?

How did you feel during and immediately after the session? Have you noticed any change in your body/mind/

emotions/spirit?

Did your practioner-in-training do anything that you would like to praise?

Did anything happen during your session that you would have liked your practitioner-in-training to have done differently?

(This is a very important question because you can help this person to improve the care he or she gives to others by your

honest and gentle feedback.)

Client's Signature_____________________________________________ Date ____________________________

Please note: Your practitioner-in-training will call you in TWO WEEKS to read back the answer you gave to the first

question and to ask: What lasting effect, in any, has this treatment has upon you? This could include physical changes, changes in attitude, emotional changes, changes in relationships, feelings of self-worth, increased motivation, better

ability to create what you want in life, etc.

Thanks for your cooperation. If you would like further information about the program, feel free to call 808 573-5719.