Date *
Date
Your Name *
Your Name
Program Location *
Medical Intuitive Training Current Level *
Module (Click most recent Module applicable) *
Session Length (Note: Certification Sessions must be 1 Hour Minimum) *
Session Length (Note: Certification Sessions must be 1 Hour Minimum)
Sessions less than :30 will not be accepted. Timings will be credited to the nearest :15 minute mark. (e.g., :50 mins will be credited as :45 mins). Only use HOUR and MINUTE boxes below - put "O" in SECONDS box.
Session Location *
Check all that apply, including Follow Up location
Client Case Study Permission Agreement *
Case Study will not be considered until Client Permission Agreement has been submitted
NOTE: - CE Students must list FULL CLIENT NAME & CONTACT INFO (phone or email). - Non-CE Students must list Client First Name and Last Initial.
Client Gender *
Program Skills Practiced in this session *
Check all that apply
You may only use Medical Intuitive Training skills for documented sessions.
Describe your experience in practicing the items checked above. Include your evaluation and assessment of each item. Be as detailed as possible.
Describe any client recommendations, referrals or care plan. Be as detailed as possible.
List any client feedback either during or after the session. Be as detailed as possible.
Is Client willing to participate in Survey of their session experience? *
Describe any Client Feedback you received in your Follow Up email or telephone call, including date of Follow up. Be as detailed as possible.