Welcome and congratulations!

Please review the Service Information Agreement here.

Please complete the form below in as much detail as possible. The more information you share with me, the better I can support you!

Name

First Name

Last Name

Best Phone Number For Shelly To Text You

Country

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Best Email For Shelly To Email You

Birthday

YYYY

Birth Time

If unknown, please try to find out

Hour

Minute

Second

Birth Location

City and Country

Have you participated in Energy Healings before?

If yes, what type of Energy Healing(s)?

If no, please type n/a.

If yes, what did you like MOST about your previous Energy Healings?

If no, please type n/a.

If yes, what did you like LEAST about your Energy Healings?

If no, please type n/a.

What are your top three goals for Energy Healings with Shelly Baca?

Please briefly explain your spiritual and/or religious beliefs, if any.

Please share any additional relevant information below:

I have reviewed the Service Information Agreement linked at the top of this page. I understand that by checking "I agree" below I am submitting an electronic signature confirming I have thoroughly examined, understand, agree to abide by all terms of the Service Information Agreement.

I agree

I do not agree

I understand that lasting results may require several sessions and that I may be required to practice self-healing and/or other reinforcement activities between sessions/at home. I am resposible for actively cooperating with and participating in my program. Shelly Baca shall not be held accountable for the results I attain.

I understand

I do not understand