Client Forms

Doris Poulin, Energy Medicine Practitioner
(719) 360-0954

Healing Touch Body and Mind Wellness Center

104 Dry Mill Road, Unit 102

Leesburg, VA 20175

Client Intake Form

If you are a first-time client, please print this form, complete it, and bring it along to our first session.

Intended Outcomes Form

This form will help you clarify your goals for your overall health and vitality, including our time together.

Note: To download Adobe Acrobat Reader for free, click here.