We would love for you to complete this form after each session or whenever you feel it’s right for you. As with all client information, your responses will be kept strictly confidential unless you choose to identify yourself or other details. Please refer to the Privacy Policy for Heart Stone Therapeutic Healing if you have any questions about privacy and your personal information.

You are also free to complete this survey by hardcopy if you prefer. If you choose the hardcopy option instead, please email our clinical director Brianna Sterling here & you will be provided a copy at your next session.

This survey should take about 2-3 minutes to complete. Not every field has to be filled out, but you will need to finish what you intend to submit in one sitting as you cannot save a partially completed form and come back to it later to continue working on it. If you want to keep a copy for your own records, please print this page on your browser before you submit the survey.