thelivemethod logo

Page 1 of 5 - LIVE Method Intake Form

Children Living in the Home
Children Not Living in the Home Full Time

Page 2 of 5 - Family History:

How would you describe your relationships with the following people. For those family members who have passed, please share what your relationship was like when they were alive.

Page 3 of 5

Parent’s Relationship: 

Page 4 of 5 - The RISO-HUDSON Quest Enneagram Test

For this test to yield the correct result, it is important that you read and follow these few simple instructions.
  • Select one paragraph in Group I and in Group II that best reflects your general attitudes and behaviors, as you have been most of your life.
  • You do not have to completely agree with every word or statement in the paragraph you select. You may agree with only 80 to 90 percent of a particular paragraph and still select the paragraph over the other two in the group. However, you should agree with the general tone and overall “philosophy” of the paragraph you select. You will probably disagree with some part of each of the paragraphs. Do not reject a paragraph because of a single word or phrase. Again, look at the overall picture.
  • Do not over analyze you choices. Select the paragraph that your “gut feeling” says is the right one for you, even though you may not agree with 100 percent of it. The general thrust and feeling of the paragraph as a whole is more important than individual elements of it. Go with your intuition. 

Page 5 of 5

I acknowledge and agree by my signature below that I understand that the LIVE Method is not intended to diagnose, treat, cure, or prevent any disease, nor is it intended to be a replacement for medical advice and/or medical treatment for any condition or problem.  I hereby acknowledge that although the LIVE Method practitioner is here to be of assistance to me in moving toward health and healing, my choices and decisions regarding my care and my life are my own choices and decisions. LIVE services are requested at my own choice and with inherent singular responsibility. The LIVE Method practitioner shall not be responsible for any loss or damage caused, or alleged to have been caused, directly or indirectly, by the information or ideas contained, suggested, or referenced in service appointments. My use of the information received during LIVE. Method visits does indicate my understanding that I am able to make my own decisions about emotional and interpersonal matters, and the LIVE Method practitioner is not responsible for any decisions that I make, or fail to make. I understand that the fields of Applied Kinesiology, Energy Medicine, and Energy Psychology are not exact sciences, and although highly positive results are intended and expected, they cannot be guaranteed.  I understand that Carolyn Berghuis is not a medical doctor, a psychiatrist, or a psychologist, but has extensive specialized training and study in the area of emotional wellness and The LIVE Method.

Please note all services are to be paid in full at the time of your visit. We do not allow any returns on all supplements as we are unable to control the temperature of these products once they leave the office. All sales are final.