SCIO CLIENT DATA BEFORE APPOINTMENT NameEmail*Contact Number*Current address*SUB SPACE SESSIONIN PERSON SESSIONWhere did you hear about SCIO?*Where did you hear about me?*Birth Place*Birth Date*Appointment Date*Number of Organs RemovedNumber of Synthetic drugs UsingNumber of smokes / dayNumber of Steroid type drugs in last yearNumber of Street Drugs used in last monthNumber of Metal amalgam fillings currentNumber of known allergiesNumber of unresolved mental factorsI am Responsible for my Body 1 – 1012345678910Amount of Processed Foods & Fats in diet 1-1012345678910Personal Stress Factor 1-1012345678910Number of cups of coffee/tea /day12345678910Number of Sugar Type Products / dayNumber of 20min + Exercise sessions / weekNumber of Alcoholic drinks/day averageNumber of extreme exposures to radiation/chemicals/yearNumber of major injuries / operations Number of major infectionsNumber of glasses of water / fruit juice /dayHow many kgs are you overweightIf there is an dis-ease in your body which you would like us to focus on please write detail here.If you wish to set an intention for the session, please think about it and give it to me at our appointment or write it in now.EmailSubmit Please enable JavaScript in your browser to submit the form
