Questionnaire | Erica Leal Body Code

First Name

Last Name

Email

Phone

How did you hear about my services?

Have you ever experienced an Emotion Code or Body Code session, or other energy work before? If yes, what kind?

Do you believe in a Higher Power? If yes, what name(s) do you prefer using (ex: God, Source, Creator, etc)?

List your top three-five problems or issues you would like to address. These could include any health or emotional struggles, limiting beliefs, relationship issues (past or present) work or money related issues, or anything else that might be significant

Do you have any comments/questions you’d like addressed prior to our first session?