As parasitic attempts to breach personal shields have increased, the need for additional protection has also increased. Your auric shield will be repaired, fortified, and upgraded to an enhanced triple overlay of protective frequency to greatly bolster your initial line of self defense.
CLIENT INTAKE FORM
Please complete this client intake form before completing your purchase.
Full Name*Required field!
Email*Required field!
Date of BirthRequired field!
How did you hear about us?*Required field!
Briefly describe your experiences with any previous energetic sessions you have had in the past.*
Did you have any adverse reactions or sensitivities?
Required field!
What is your primary reason for seeking this service?*Required field!
Do you have any existing medical conditions that you feel we should know about before your session? Please list all health concerns including allergies or sensitivities.*Required field!
Are you pregnant or have reason to believe you might be?*Required field!
Do you have a pacemaker or cardiac condition?*Required field!
Do you have a known seizure condition?*Required field!
I confirm that the information recorded above is complete, accurate, and honest to the best of my knowledge. I understand that energetic therapies are not a replacement for medical treatment, and that the energetic facilitator may only perform treatments within his or her scope of practice and level of comfort. Anything said during this session shall not be regarded as medical advice, treatment, diagnosis, or prescription. I agree that I have been given sufficient opportunity to ask questions and make specific requests in order to make my appointment time as comfortable as possible. I have also read and will abide by all policies and client expectations that may be listed separately from this document, including but not limited to the store policy regarding scheduling and no-shows.*Required field!
Cancellations within 24hrs of your service purchase will be issued a refund minus an administration fee of 30% of total purchase. Any cancellations past 24hrs of purchase are not eligible for refunds. Any session not claimed/scheduled 12 months after purchase date are voided and not eligible for refund. Your session date will only be held for 24hrs during the scheduling process. If there is no response to our scheduling email, the appointment time previously offered will be released and another (later) date/time will be offered based on scheduling availability. We will only attempt to schedule 3 times before we void the purchase with no refund. NO REFUNDS FOR SERVICES THAT HAVE ALREADY BEEN RENDERED. EMMIE EVOLVING RESERVES THE RIGHT TO REFUSE SERVICE WITH NO REFUND OFFERED. ANY VIDEO RECORDINGS OF SERVICES RENDERED ARE STRICTLY THE SOLE PROPERTY OF EMMIE EVOLVING. **Required field!
Although every effort appropriate will be taken during your session to provide the best possible results, there are no guarantees expressed or implied as to what the results will be. Each circumstance and client is unique and their sovereign free will is always honored.*Required field!
I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS Emmie Evolving PRIVATE SESSION, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault. I certify that I am physically fit, have sufficiently prepared for participation in this activity, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity. I acknowledge that this Accident Waiver and Release of Liability Form will be used by Peaceful Warrior Project LLC, Emmie Evolving, the event holders, sponsors, and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In consideration of my application and permitting me to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: * (A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Emmie Evolving, Peaceful Warrior Project LLC and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; * (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that they are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by my personal intellectual terrain, faculities, temperature, weather, energetic condition of participants, equipment, lack of hydration, and actions of other people or energetic entities including, but not limited to, participants, volunteers, monitors, and/or producers of the activity. These risks are not only inherent to participants, but are also present for volunteers. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. I understand while participating in this activity, I may be video recorded. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.*Required field!
PRIVATE SESSION QUESTIONS/COMMENT:
Please share whatever you feel called to share regarding your private session.
