Client Information Form

Thank you for your interest in working with Kimberly Dam. To be sure that a session feels like a resonant fit at this time, please fill out the Client Information Form as honestly as possible and submit it at your earliest convenience. We appreciate your care and understanding and look forward to connecting again soon.

First Name

Last Name

Phone

Birthday

Time of Birth (Please provide if you'd like me to pull your astrological birth chart.)

Birth city (Please provide if you'd like me to pull your astrological birth chart.)

Where are you located?

How did you learn about Kimberly Dam and her work? Google, Instagram, etc? Did someone refer you? If so, who?

Where in your life do you feel the most misaligned?

What are the top 3 nagging loops or thought patterns that keep showing up that hijack you from being in the pleasure of the present moment (aka worrying about what has happened, anxious about what might happen next)?

Do you have a preexisting spiritual practice?

Do you have a preexisting self pleasure practice?

Describe your relationship to your body.

Describe your relationship to money.

What is the big dream that turns you on and freaks you out?

What inspired you to seek Kimberly Dam's support? Do you have a specific intention in working with her?

Sessions and multidimensional spiritual teachings can sometimes be unpredictable and feel differently each time. Kimberly Dam's teachings may also not feel linear or easily contained within Western constructs of learning. Do you feel you can enter the unknown with her?

Is this type of session something you see as a one-time session or support you’d like to receive over time with multiple sessions?

Sessions with Kimberly often involve being seated or laying on a thick floor cushion. However should you have any mobility issues, alternative accommodations can be provided. Simply let me know by filling in the space below.

Kimberly Dam is guided by both her intuition and her connection to Spirit. Being with Kimberly Dam in sessions such as a healing session can activate change, growth, and healing. Is this something you desire?

Do you feel called to share anything more in relation to your healing or personal growth at this time?

I, the signee of this application, NOW take 100% responsibility for my physical, mental, emotional, spiritual, financial, sexual, and ALL ENERGY and transactions in the relationship between myself and Kimberly Dam.

100 percent!
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Client Information Form

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