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New Client Form

All new clients are required to fill in this completely confidential form when booking their first session. This greatly helps streamline the session, and provides the history I need to prepare in advance.

Questions?

Email me:

ash@medicinewalker.com

First Name

Phone

Last Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Birthday * required

Company

Position

What draws you to shamanic healing? Check all that apply. * Required

Help for myself

Help for a loved one (their consent is required) - including an animal

Help for a relationship

Deepening my connection to the Earth

Finding a spiritual practice that resonates with me

Something else (please describe below)

Concerning symptoms you'd like addressed: * Required

Energy levels

Sleep issues

Chronic pain

Acute pain

Mental and/or emotional trauma

Surgery preparation and/or recovery

Social struggles

Family dynamics

Something else (please describe below)

Please tell me in detail what you'd like to receive from shamanic healing or counseling sessions.

If you have any relevant health conditions I should be aware of, please let me know here, including allergies, or symptoms I should make accommodations for in sessions.

If there is medical information you'd like me to see before we meet, such as X-ray films, you can upload it here.

Upload File

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Are you on any supplements or medications?

I understand shamanic counseling and healing is not the same as medical care or psychotherapy, but part of a holistic approach to wellness. I am aware that musical instruments may be part of the sessions, and will take care of any hearing protection I wish to bring, especially if I experience tinnitus.

I will seek appropriate medical care and therapeutic services for my conditions while shamanic treatment is ongoing. I understand that there can be no guarantee of outcomes with soul-level healing.

Best days & times for a session

Session Location Preference *

Zoom

In-person at my home

In-person out in Nature

In-person at The Horned Toad Art Studio in Eldorado/Santa Fe ($25/hr rental fee)

Your Signature

Select a date

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Santa Fe, NM

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