Flourish by Design Intake Form

Hello! I'm so excited for our work together. I look forward to aligning with you to clear out the old gunk that holds you back, and guiding you into a new life that is aligned with your desires, values, and intentions.

I just need a little bit of information from you before we dive in.

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Energy healing is not a replacement for medical care, nor is it a substitute for professional psycho-therapeutic or counseling sessions in the treatment of any mental health issues or disorders.

 

I understand that if any facilitator makes any suggestions regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, or any compounds or any external remedies of any kind, that I use or ingest such at my own risk, with the recommendation that I seek the advice of a physician or my health care provider before using any such remedy.

 

I understand that in a minority of Emotion Code sessions, the release of trapped emotions or other energies may result in “processing” where echoes of the emotions released may manifest in temporary physical or emotional discomfort, and that this “processing” appears to be a normal part of regaining energetic balance.

 

I understand that Reiki/Emotion Code/PSYCH-K® and any other forms of energetic healing and/or energy transmission are stress reduction and relaxation techniques. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Anné M. Klint and Flourish by Design from any and all claims or liability of any kind or nature arising out of or in connection with my session(s).

 

No representation is made or intended as medical advice and should not be used for diagnosis or medical treatment. If you have questions or concerns about your health, contact your healthcare provider. No claims are made regarding healing or recovery from any illness.

 

All sessions are confidential, and your personal information will not be shared without your express, written consent.

 

I understand that by signing this form by typing my name into the box below that I fully consent to participating in Reiki/Emotion Code/PSYCH-K® and any other energetic healing sessions with Anné M. Klint.