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 Minor 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 my minor child. I, being the parent or legal guardian of the client, a minor under the age of 18, give my written consent for such services.
Please carefully read these statements and sign below.
I understand that:
- I understand that holistic 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 my child experiences pain or discomfort for any reason during the session, they 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 experienced during or after the session.
- I affirm that I have notified Lori Beasley/Free Spirit Heart of my child’s all known medical conditions and injuries.
- I agree to inform Lori Beasley/Free Spirit Heart of any changes in my child’s 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 my child will remain fully clothed for the entire session and the services are non-sexual in nature. Disrobing is not allowed. My child is allowed to remove any shoes and socks. My child may request to be covered with a blanket for temperature control and comfort. The front torso area will not be touched. My child will not be touched at all at the request of me and my child.
- I understand that it is suggested for my child to be alone with Lori Beasley/Free Spirit Heart so they are free to express themselves during this session. If I choose or allow my child to choose that I not remain in the room, it is of my own choice with consent for the practitioner to work with my child.
- 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.
I release and hold harmless Lori Beasley and Free Spirit Heart.