Client Intake Form

Name(Required)
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Patient Name (if Minor)
Address(Required)
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Have you ever worked with a life coach, counselor, therapist, psychiatrist or psychologist?(Required)
Have you ever experienced Guided Imagery, Yoga, Meditation, Hypnosis or Energy Healing?(Required)
Do you have any fears or phobias?(Required)
Digital Signature(Required)
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About

Karen assists her clients in connecting with their higher self to explore their values, limiting beliefs and negative self-talk, so they may live a balanced, peaceful life, make healthier choices, take intentional action, build emotional resilience, awaken to their unlimited potential within and Just Be.

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Contact

karen.justbellc@gmail.com