Forms

Please complete the online Membership form and the Liability Waiver and Release Form below prior to booking your first appointment. These are Required Forms.

Please arrive at least 20 minutes early for your first appointment to meet staff and sign in.

Private Membership Form

FREE

Required for all bookings. Only need to complete one time.

Private Membership Terms and Conditions

Liability Waiver and Release Form

Required for first appointment only. Please complete on-line form below, check box that you are in agreement and sign prior to your first appointment.

Liability Waiver and Release Form

First Name

Last Name

I understand that products and services offered by Energy Healing Room support the body, mind, and soul's natural ability to create wellness in my life. I understand that Energy Healing Room facilitators do not diagnose conditions, nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that energy healing, or any service provided by Energy Healing Room does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physiological or psychological ailment I may have. I understand that energy healing provided by Energy Healing Room can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. Energy Healing Room is not liable for my medical, mental, or emotional conditions before, during, or following any service provided by Energy Healing Room I take personal responsibility for my well-being and with respect for myself I gratefully accept control of my choices. My heirs, guardians, legal representatives, and I hereby and forever release, waive, and discharge any claims against, Energy Healing Room and/or any of their associates or affiliates. I take full responsibility and am responsible for all liability for loss or injury incurred while in association with Energy Healing Room and/or any of their associates or affiliates. I have carefully read this agreement and fully understand its content. I am aware that this is a waiver and release of potential liability and a contract between the above noted parties and myself. I understand that this contract is binding and acknowledge that I am signing this of my own free will.

Your Signature

Thanks for submitting!

"The Future of Healing is Here!"

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Forms

Private Membership Form

Private Membership Terms and Conditions

Private Membership Form

Liability Waiver and Release Form

Required for first appointment only. Please complete on-line form below, check box that you are in agreement and sign prior to your first appointment.

Liability Waiver and Release Form

"The Future of Healing is Here!"

Click on icon below

Forms

Private Membership Form

Private Membership Terms and Conditions

Private Membership Form

Liability Waiver and Release Form Required for first appointment only. Please complete on-line form below, check box that you are in agreement and sign prior to your first appointment.

Liability Waiver and Release Form

Liability Waiver and Release Form

Required for first appointment only. Please complete on-line form below, check box that you are in agreement and sign prior to your first appointment.