New/Updated Client Information Form
Energetic Apothecary - Reiki For Wellness - Tammy Schoolcraft
317 Matthews Mint Hill Rd Suite 108, Matthews NC 28105
                       
 *** PLEASE DO NOT COMPLETE THIS FORM UNTIL YOU HAVE SCHEDULED YOUR APPOINTMENT 
Also, If you booked directly through my scheduler you have already completed this step so no need to do it again. 

Welcome!  I am excited to be working with you! Once you have scheduled your session, please fill out the following information and consent to treatment prior to your appointment.

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Unimpeded and free-flowing breath is not only important to your health and mine, but it is also an important part of this work in order to release blockages from the body. Please note for In-Person Sessions - You acknowledge and understand that you are receiving treatments knowing that social distancing cannot be adhered to. - 

If this is a concern please choose the option of Remote session via zoom or phone.

***All NO SHOW"s without respectfull cancellation will be Assessed a $50 Fee to the card on file**
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First and Last Name *
Email Address *
I am interested in the following services... *
Required
Date of Birth.  Month/Day/Year *
Current Age *
Phone Number Best to contact you and receive text appointment confirmations *
City, State where you live *
How did you hear about me or whom may I thank for a referral? *
What issues (if any) physical or emotional would you like to work on during our time together in order of priority? *
Current Medical Conditions or dianosis that I should be aware of *
Check any of the following that apply to you *
Required
Is there anything else that you would like for me to be know before our session together?
Treatment Consent - All Sessions
The treatments provided are not intended to replace the advice or care of a licensed physician. I am not a doctor and I do not diagnose or prescribe.
 
Any Information shared during your sessions at any time regarding supplements, herbs, homeopathic remedies or natural/holistic resources ARE SUGGESTIONS ONLY. I do not make healthcare decisions for you. Any such suggestions do not replace the advice of your medical doctor and you should never stop any prescribed medication without the advice and direction of your medical doctor.

Treatments with my practitioner are not intended to diagnose, treat, or cure disease, but to support the body’s natural ability to heal itself. By signing this form, I understand that there can be a detox effect from energy/body work and if it lasts greater than 4-5 days, I should contact my practitioner and/or a licensed medical professional.

There are no known contraindications for energy work, however, caution and consideratoin should be discussed with and discolosed to your practitioner if you are have the following: Pacemaker, concussion less than 6 months, currently undgoing cancer treatments/radiation, terminal Illness, pregnancy, history of seizures.

By signing below you are indicating that you have read and understand and will disclose to the best of your ability any conditions that may be of concern

Under 18 years of age  - parent please sign consent on behalf of your child to treat below

Signature *
Date *
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