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All About You Wellness Centre

Client Information Sheet for Person Under 18 Years of Age with Louie Chan

Date *

Name *

First

Last

Date of Birth: *

Please describe in your own words what you would like to accomplish in your sessions, and how you would expect your life to change once you accomplish it? *

I choose to attend this session upon my own free-will.
I am open and willing to participate in the session by engaging in conversations and participating in the process as best as I can.
I understand that these sessions are intended to help me meet my desired objective, grow, and improve my circumstance(s).

Please type your name to confirm all the information above. This will serve as your e-Signature.

Date Signed: