CLIENT CONSENT FORMPlease Note: All information provided is private and confidential. No information about any client will be shared with any third party without written consent from the client or parent/guardian if the client is under 18 years of age.Client Information Full Name * Mobile or Home Phone Number * Email * City * Sex * Occupation Relationship Status Children & Ages Women Only: Are you pregnant? Yes No Emergency Contact Name Emergency Contact Phone Number Health Information Are you currently under the care of a physician? Yes No If yes, please provide the physician's phone number: Please list any health issues or requirements you would like me to know about (including health restrictions, allergies, or other concerns) Are you taking any medication? Yes No If yes, please list Do you use recreational drugs? Yes No If yes, please specify Healing Experience Have you ever had a healing session before? Yes No How would you describe your previous healing experience? Did you notice any results? Yes No If yes, please describe Are you sensitive to touch? (In-person only) Yes No Consent and AcknowledgmentI understand that the Reiki and healing sessions provided by Psychic Newsha involve a natural method of energy balancing aimed at stress reduction, relaxation, and healing.I acknowledge that:These sessions are not a substitute for medical treatment and do not interfere with the treatment I may receive from a licensed medical professional.I take full responsibility for my own health care and maintenance.Nothing communicated by Psychic Newsha is intended to diagnose, prescribe, or treat any medical condition.I have disclosed all relevant information regarding my health that may affect the services provided.If I experience any discomfort during the session, I will voice my concerns immediately.Complete relaxation is often beneficial for healing, and long-term imbalances may require multiple sessions.I must provide at least 24 hours' notice if I wish to cancel my appointment and receive a refund. I understand I can request to stop the session at any time, but this may not entitle me to a refund.I have read and understood the terms and conditions outlined above.By signing below, I acknowledge and fully agree with all the above information.Client Signature Signature date (D/M/Y) * Please tick this box to confirm your agreement. * TICK THIS BOX AS YOUR SIGNATURE. Thank you for your cooperation. I look forward to supporting you on your healing journey. Submit
