Client Consent

I hereby request and consent to the performance of energy healing modalities and treatments within the scope of the practice of Energy Healing Practitioners on me ____ (or on the patient named below, for I am legally responsible) by the Energy Practitioner ____.

I understand that methods of treatment may include, but are not limited to: Access Bars, energy balancing and harmonization, Psychic Surgeries, reiki, medical intuition, chakra harmonizations, energy healing, past life, in-between and future life journeys, meditation, visualizations, hypnotherapy, counseling, and psychoenergetic energy work.

I have been informed that energy medicine is a generally safe method of treatment, but when shifts in energy occur and may create some physical, emotional or spiritual changes which may include physical tingling, feeling lighter energetically, mild fatigue, nausea, muscle soreness, headache, thirst, changes in relationships, shifts of perception, etc. I do not expect the energy practitioner to be able to anticipate and explain all possible risks and complications of energy treatment, and I wish to rely on the energy practitioner to exercise judgment during the course of treatment which the energy practitioner exercises a best and highest interest for healing, based upon the facts then known and for my best interest and highest good. I understand that results and thereby give my consent below.

I, ____, am here to inspire my own personal transformation. I take personal responsibility for my well-being, and with respect I gratefully accept the following healing process. My heirs, guardians, legal representatives, and I hereby and forever release, waive, and discharge any claims against, ____ or any of their associates or affiliates. I take full responsibility and am responsible for all liability for loss or injury incurred while in association with or applying energy techniques or any of their associates or affiliates.

I hereby give my consent to share the full information (as in complete history and background) about the concerned issue or illness all at once (by recalling it thoughtfully and very carefully at once, as desired by the Energy Healing Practitioner for the clear understanding of the entire case).

I also hereby give my consent to being fully attentive receptive, exceptance, mindful and surrender in listening and throughout the process till the last shared by the energy healing practitioner to me. Duly noted and abide by all in exact accord very sincerely for good result.

Note on Healing process:

1. There will be a customised healing process on case to case basis. That the Energy exchange (fee) will be taken in advance on monthly basis.
2. I voluntarily consent to participate and start my healing process and understand that I cannot stop this process once it has been started and also I am aware of all the consequences as explained by energy healer.
3. I have carefully read this agreement and fully understand its content. I am aware that this is a waiver and release of potential liability and contract between the above noted parties and myself. I understand that this contract is binding and acknowledge that I am signing this of my own free will.
4. I understand that all clinical information and records of energy healing treatments etc will be kept confidential.
5. By voluntarily signing below, I show that I have read or have had read to me, the above consent of to treatment, have been told about the risks and benefits of energy medicines and intuitive energy healing and other energy modalities, and have had an opportunity to ask questions. I intend this consent form to cover the entire course and process of my energy treatments for my present condition and for any future conditions, for which I seek any energy healing modalities.