top of page

Luxe Wellness Intake Form

Thank you for taking the time to fill this out prior to your coaching or energy therapy session, event or retreat. We will be in touch if we require any further information from you.


Your privacy is our priority & all information will be kept confidential.

Intake Form

Please complete the following patient information in order to participate in our coaching programs, events or retreat activities.

Thanks for submitting!

bottom of page