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Healing Hearts Holistics

New Client Intake Form

Welcome! 

I’m so glad you’re here. This form helps me get to know you and your goals, so we can make the most of our sessions together. Your responses are private and confidential and will never be shared without your permission.


This form is used for sessions provided by Beth Botts, Certified Emotion Code®, Body Code™, and Belief Code® Practitioner, through Healing Hearts Holistics LLC.

Sex
Male
Female
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© 2026 Healing Hearts Holistics.

All rights reserved.

"He restoreth my soul." - Psalm 23:3

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