MQG Home Practitioner Therapist Master's Tuition Registration Graduates Free Clinic
*Name (first and last)
*Email required for response
*Phone required for connection back-up
*What day would you like to receive a session?
*Session time
*Zoom required for participation
Anything you would like to add about your availability?
Pregancy
Age
*How would you classify your session?
1. Please describe condition as far as is comfortable for you to share. This will help the students prepare for your session.
2. How long have you had this condition?
3. Are you currently undergoing any treatment or therapy for this issue?
4. What kind of treatment or therapy (briefly)?
5. Are you open to exploring the Mental, Emotional and Spiritual aspects pertaining to your health and wellness?
6. Are you willing to spend some time doing Qigong prescription exercises?
6. What would you like to get out of your session?
7. Is there anything else that you feel it is important for your therapist to know?
How did you hear about the clinic?
* I understand that the person who I will be working with is not a Medical Doctor and does not medically diagnose, treat or prescribe. I understand that this is a Medical Qigong student clinic that I am volunteering for and that information about this session might be shared anonymously as part of the student's learning experience.
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