New Connection & Intake Form

Welcome to Metaphysical Coding® with Cherie.

Thank you for taking this step.
This form helps me understand your needs so I can create a healing experience that supports your whole self — mind, body, and energy.

Take a quiet moment to complete this form before your first session. When you’re ready, click ‘Submit’ to confirm your agreement and open the space for your healing journey to begin.

Personal Details

First Name / Preferred Name

Phone

Post Code / Zip Code

Age Range

Occupation

Session Details

Who is this session for?

If applicable - Child/Ward's Name & Age

Parent/Guardian Consent I confirm I am the parent/legal guardian and give permission for my child/ward to receive an energy healing session. I understand this supports overall wellbeing and is not a substitute for medical or psychological treatment.

I agree

Getting to Know You

How did you hear about me?

Is this your first energy healing experience?

Yes

What brings you here today? Please share your main reason for booking (e.g., emotional, physical, or spiritual concern).

What would you most like to experience or achieve through this session or ongoing work?

Anything else you’d like me to know before we begin?

Healing Approach

Energy healing unfolds differently for everyone. Some people experience deep release right away; others prefer a slower, gentler pace. Please choose the pace that feels right for you:

I’m ready to go as deep as needed, even if I feel more emotional or sensitive afterward.

I prefer to ease into the process gently, across several sessions.

Consent & Agreement

Before we begin, please read and tick to confirm your understanding:

I understand that energy healing supports emotional, physical, and spiritual wellbeing but is not a substitute for medical, psychological, or therapeutic treatment.

I acknowledge that my results depend on my own engagement and readiness to take aligned action. I may experience emotional or physical shifts after a session as my energy integrates — this is part of the natural process.

I understand that sessions are non-refundable. With at least 24 hours’ notice, I may reschedule or offer my booked time to another person. All information shared is treated as strictly confidential.

I have read and understood the full Terms & Conditions and give my consent to receive energy healing with Cherie Jackson.

(Please click the link above to view the full terms before submitting this form.)

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New Connection & Intake Form

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