Thank you for connecting with Free Spirit Heart! We look forward to seeing you soon. Please complete this new client form before arriving to your appointment.
New Client Statement/Waiver
I am hereby requesting a holistic energy session (which could include Chakra Balancing, Metaphysical Healing, laser therapy, Reiki, Spiritual Counseling, intuitive guidance and the likes) for myself.
Please carefully reach each statement:
- I understand that energy work and other services provided are for stress reduction, relaxation, energy flow, guidance and empowerment.
- I understand that the services offered today are not a substitute for medical care. I understand that Lori Beasley/Free Spirit Heart is not qualified to perform spinal or skeletal adjustments, diagnose, prescribe, or treat physical or mental illness.
- If I experience pain or discomfort for any reason during the session, I will immediately inform Lori Beasley/Free Spirit Heart so that we can discuss and/or suspend the session. I will not hold Lori Beasley/Free Spirit Heart responsible for any pain or discomfort I experience during or after the session.
- I affirm that I have notified Lori Beasley/Free Spirit Heart of all known medical conditions and injuries.
- I agree to inform Lori Beasley/Free Spirit Heart of any changes in my health and medical condition. I understand that there shall be no liability on Lori Beasley/Free Spirit Heart/s part should I forget to do so.
- I understand that energy work and other services provided are entirely therapeutic and not a form of massage.
- I understand and agree that I will remain fully clothed and the services are non-sexual in nature.
- I understand Lori Beasley/Free Spirit Heart will provide professional confidential support with the utmost respect in a positive manner without judgment.
- I understand that, because energy work involves close physical proximity over an extended period of time, there may be an elevated risk of disease transmission, including COVID-19.
- By signing this form, I hereby release and hold harmless Lori Beasley/Free Spirit Heart from any and all liability, past, present, and future relating to services provided to me.