Client Information & Consent Form

Thank you for your interest in our Energy Healing Sessions. In order to better serve you, we would like some information about you. In addition, please read and submit our consent form which informs you about our Energy Healing session. This information is sent directly to us and is not retained on this website, we do our best to ensure your information stays private.

Client Consent Form

This is an agreement between the client and Spiritual Spectra (the practitioner) concerning the Energy Healing Session(s) and upon submitting this agreement the client agrees to all terms laid out in this agreement.

1. I authorize and request my practitioner to carry out Energy Healing sessions. I understand the process of these sessions will be explained to me upon my request and that they are subject to my agreement. I also understand that while the course of my session is designed to be helpful, my practitioner can make no guarantees about the outcome of my session. Further, this process can bring up uncomfortable feelings and reactions such as anxiety, sadness and anger. I understand that this is a normal response to working through unresolved life experiences and that these reactions will be worked on between my practitioner and me.

2. I am at least 18 years old, the age of consent to make any decisions as to my person and treatment.

3. I understand that as part of the session the practitioner may lay her hands lightly on my body, particularly on head and over the heart and stomach. However, this will be done only with my consent. I will remain fully clothed during my session but watches, cell phones and any other electrical, metal or magnetic items will be asked to be removed.

4. It is my responsibility to notify the Practitioner of any current medical conditions and medications, allergies, recent surgeries, transplants, prosthesis, pacemaker or any other electrical, metal or magnetic item in my body. I understand that Energy Healing is intended to help the client and any medical or psychiatric issue or condition that occurs during or after the Energy Healing session is not the responsibility of the practitioner. In addition, the practitioner will not be held liable for any information withheld by me as to my medical or emotional conditions. I will not hold the practitioner responsible or seek compensation for any injury or illness suffered by me caused in whole or in part by my participation in this session.

5. Receiving an Energy Healing treatment will not interfere or replace traditional medical or psychiatric care but can enhance other medical/psychiatric treatments. Therefore, clients under current medical or psychiatric care should not stop treatments or medication without advice of their physician/psychiatrist.

6. For maximum benefit, it is recommended that you do not consume any alcohol, caffeine, energy drink, nicotine or very spicy foods and practice moderation in exercise, work and temperature 12 hours prior and 12 hours after an Energy Healing session.

7. Any communication via email or cell phone may not be secure, so we will assume that you have made an informed decision when using these communication channels to provide information and are taking the risk of such communication being intercepted.

8. It may be necessary at times for us to leave or send you a message at the phone numbers and email addresses you provide us. By supplying us with specific phone numbers and email addresses, you authorize us to leave messages for or send messages to you.

9. All information between practitioner and client is held strictly confidential. There are legal exceptions to this:
a. The client authorizes a release of information with a signature.
b. The client presents as a physical danger to self or others.
c. Abuse and/or neglect are suspected.
d. The client is under criminal investigation and a subpoena by a court of law has been issued for information on the client.
In the case of #b or #c above, we are required by law to inform potential victims and legal authorities so that protective measures can be taken.

10. I understand that I am responsible for payment of all fees charged at the time of service to be paid either prior to or on the day of service. I agree to pay for all services rendered.

11. I am expected to arrive on time on agreed upon appointment date and time. If I am 30 minutes or more tardy, then I will be charged for this time accordingly. Cancellations must be made at least 48 hours prior to appointment; otherwise I will be responsible for full cost of session. Should there be an emergency, no charge will be made, however, proof of said emergency will be required to void payment requirement.

12. Practitioner(s) reserves the right to refuse any session without providing a reason and can cancel said session at any time. Any payment made prior to a session that is canceled by the practitioner will be refunded in full.

13. I understand that my relationship with my practitioner is entirely professional and so any behavior on my part that is not professional and can be deemed sexual or abusive will be reported to the authorities.

By submitting below, I certify that I have read and understand this agreement and have full knowledge of its meaning and effect. If I violate the agreement, I know that the practitioner may discontinue sessions.