RIM® is a revolutionary emotional processing system that leverages the physical sensations of the body and the power of the subconscious imagination to bypass logic and get right to the heart of the hidden sources of pain.

Client Intake Form

First Name *

Middle Name

Last Name *

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Emergency Contact *

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Have you ever been hospitalized for mental health reasons? *

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Have you ever been diagnosed with psychosis, schizophrenia, bipolar or paranoia? *

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Are you taking medications for psychological reasons? *

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If Yes, please list medications

I understand RIM^® is a form of transformational facilitation that unleashes inner resources for self-insight and healing. Through this process, I have the opportunity to observe, learn about, and clear emotions and behavior patterns that have blocked me from having what I want. I accept and take full responsibility for what I may learn and the feelings I may have that develop during or subsequent to the RIM^®session.

Operating from a holistic model, RIM^® is very different than psychotherapy, traditional counseling and life coaching. I understand that my RIM^®Facilitator is not practicing psychological therapy or counseling.

Except in the case of gross negligence or malpractice, I or my representative(s) agree to full release and hold harmless Michael Kline, Kline Training Group, LLC, Deborah Sandella and the RIM Institute from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).