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GET IN TOUCH

Contact

Private sessions are offered on a limited basis and by application only.

For inquiries, please contact:

chorig@selfempowermentnow.com

"The greatest wealth is health."

VIRGIL

Intake Form

Self Empowerment Now

​Thank you for your interest in my private integrative wellness work. This form allows for an initial review to assess alignment and readiness for a three-month foundational journey. All information is held in strict confidentiality.

Client Information

Intent & Readiness

Current Support

4. Are you currently under the care of medical or mental health professionals?

Acknowledgment

Please review and acknowledge the following:

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