Client Intake Form
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Email *
Name *
Phone *
What prompted you to schedule this call?
What are your biggest challenges right now?
What is the main goal you would like to achieve by working with me? *
Have you tried any healing practices like Qigong, EFT, or meditation before? If yes what has been your experience?
Is there anything else you would like me to know before our call? 
I agree to be contacted regarding this session and understand that this is not a substitute for medical advice

Print name to sign below:
*
Session Date & Time *
You can also book directedly on      https://calendly.com/sangita019
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Time
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Responsibilities and Liability Release *
1. I am willing to be guided through relaxation, visual imagery, Qigong, EFT, Chakra,/or stress reduction energy healing techniques. I am aware these modalities are non-medical in nature and it is my responsibility to consult my regular doctor about any changes in my condition or changes in my medication. 2. I understand the above modalities are not substitutes for regular medical care and I have been advised to consult my regular medical doctor or health-care practitioner for treatment of any old, new or existing medical conditions. 3. I understand that change is my own and complete responsibility. I understand that ALL HEALING IS SELF HEALING and that Sangita Patel is only a “facilitator” in the process of helping me to solve my own problem(s). It is my responsibility to be open and honest, provide accurate feedback and be forthcoming with details and information that may help me achieve my outcomes. 4. I understand I may be assigned “homework” or be asked to make changes to my life by my higher self in regard to complete or solidify any healing or changes begun in our session today. I understand that this information and advice for change comes not from the facilitator, but from my own higher being. 5. I understand that my facilitator may elect NOT to proceed with the session if she/he feels it is not in their or your best interest to do so. My Facilitator is NOT liable for travel costs (airline, hotel, etc.) associated with declining a session. 6. I understand that our session will be digitally recorded for my later use. 7. I agree to full release and hold harmless Sangita Patel  from and against any and all claims or liability of any nature arising out of, or in connection with, my sessions.
Special Use of Information: *
I understand that my name and personal information will be kept completely confidential. I understand that I may share my recording and information in the future in any way that I am personally comfortable. I understand that often in healing sessions, universal information is provided through the client to benefit all of humanity. I agree to allow Sangita Patel  to share this information and any accompanying story summary either in audio or video or in written form in blogs or books as long as my identity, name and all relevant personal details are omitted or changed.
Client Please Print Your Full Name to Sign Below *
I have read and understood everything written in this form. 
Date *
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How did you hear about Sangita Patel? *
CANCELLATION POLICY
You may cancel or reschedule your appointment 24 hours before your scheduled appointment.
Cancellation charges of $55.00 will be applied if you cancel  last minute or within 24 hours.

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https://atranquillifeva.business.site

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