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Health Intake Form

Hello and thank you for trusting Starling Spiritual Healing with your Reiki healing session! Filling out this form completely and honestly will help Mandy to provide you with the best possible experience. The day of your appointment, please arrive to your video appointment on time and be in a quiet, comfortable place where you won't be disturbed.

*Starling Spiritual Healing, LLC has a strict 24 Hour cancellation policy for all sessions. If you are unable to make your appointment and need to reschedule, please email StarlingSpiritualHealing@gmail.com at least 24 Hours prior to your scheduled appointment, for a full refund. Failure to abide by this policy, will result in a forfeit of your payment. In addition, anyone who shows up later than 10 minutes from the start of their appointment and all no-shows will forfeit their payment and will not receive a refund. 

All your information is strictly confidential and is only used by Starling Spiritual Healing to best address 

Please note that I am currently only conducting Distance Healing Sessions online via video conferencing, so we will not be physically meeting in person. If you have concerns about this, please Contact Me or check out My Reviews.

No energy healing practice is a substitute for established medical care.  Energy Healing is a complement to medical treatments and has been shown to enhance the effectiveness of such treatments. You are strongly encouraged to continue all treatments and medications provided to you by a physician.

Confidential Client Information Form For Energy Healing Sessions

Birthday
Please Confirm That You Are 18 Years Old or Older As of This Date
I Am 18 Years or Older

You Must Be 18+ For All of Starling Spiritual Healing's Sessions

Communication Preferences
Lots of Communication
I Just Want to Hear the Important Insights
No Talking, Just Music

During your session, what kind of communication do you wish to receive? Do you prefer to listen to healing music throughout with minimal discussion or do you want to receive insights and information on what the practictioner is doing and feeling throughout the service?

What Energy Healing Services Have You Previously Had?

By providing my electronic signature below, I hereby accept, understand, and confirm that Starling Spiritual Healing, LLC does not diagnose illness, disease, or mental disorders, nor do they prescribe medical treatment or pharmaceuticals.  I also affirm that it has been made clear to me that the practice of Energy Healing is not a substitute for medical examination, diagnosis, or treatment, and that it has been recommended to me that I consult with a medical practitioner such as an M.D. or N.D. for any physical or mental ailment that I may be currently experiencing or may experience in the future.


I agree and confirm that Starling Spiritual Healing cannot be held liable for any problem, real or imagined, that might arise as a result of participating in Energy Healing sessions.  I also affirm that I have provided a true and complete representation of my physical, emotional, and mental health by way of disclosure above and will update such information with my practitioner as conditions change or as necessary.


I understand and affirm that Starling Spiritual Healing does not claim efficacy for any treatment(s), specific outcomes, or results.  I agree to release, indemnify, and hold harmless Starling Spiritual Healing, LLC., from any claims of injury, malpractice, non-disclosure, or lack of informed consent.


I furthermore affirm that I freely elect to receive energy healing treatments of my own free will.  I agree that I have been given enough opportunity to ask questions and make specific requests to make my treatment time as comfortable as possible.


Lastly, I agree to abide by all policies set forth by Starling Spiritual Healing.

I Agree to All of the Above Terms and Conditions
I Agree
I Understand That All Starling Spiritual Healing Sessions Are Conducted Online and Not in a Physical Location
I Agree
I Agree to Act Respectfully During My Session. I Understand That Any Inappropriate Behaviors Will End My Session Immediately, Without Warning or Refund. Furthermore, I Agree That Legal Action Will Be Taken Against Me, If Necessary
I Agree
I Will Abide to the 24 Hour Cancellation Policy. If I Cancel Within 24 Hours of My Appointment or Show up More Than 10 Minutes Late, I Will Forfeit My Payment and Will Not Be Refunded
I Agree

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