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Client Intake and
Services Agreement/Informed
Consent Form for
Sound & Energy Healing

For new and returning clients, please complete the Client Intake Form listed below. Your response enables Heather Anayaya to best prepare for your session. 

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Discover the Power of Sound Healing

Client Intake and Service Agreement/Informed Consent Form
for Sound and Energy Healing

Please respond to each section.

Your typed signature verifies your consent to the enclosed Terms of Use.

Are you currently experiencing a medical or mental health condition, illness, or injury?
Do you have a pace maker, have metal parts or inserts in your body, have suffered concussions, use an insulin pump, wear a hearing aide or have another form of hearing device?

Please read these Terms of Use carefully before scheduling your sound and energy healing session with Heather Anayaya. By signing this form you agree to be bound by these Terms of Use.

The United States of America currently has no licensing policy regarding sound or energy healing, and Heather Anayaya is not a licensed medical doctor or therapist. She does not deal with medication, nor does she issue a diagnosis or cure. 

The purpose of sound and energy healing is to provide a safe space for clients to experience healing through natural, non-invasive processes. Heather Anayaya considers the use of sound, energy, intuitive guidance, and essential oils to encourage the body to return to optimal functioning, and everyone reacts to these methods uniquely and individually. Heather Anayaya makes no claims for their medical actions.

As a client of Heather Anayaya, you agree to make your own choices as to what you do with the information you have been offered and are solely responsible for your own decisions and actions. It is always Heather Anayaya's recommendation to seek out the advice of a licensed healthcare professional whenever you feel it is necessary regarding your physical, mental, and emotional health, especially with serious conditions. 
 
Clients need to consult with their physician and get approval before attending sound healing sessions if they have metal in their bodies, suffer from a concussion, have a pacemaker, use an insulin pump, and other similar situations. If in doubt, consult your physician or mental health practitioner before your scheduled session. 

Disclaimer: The services, materials, and opinions communicated by email, telephone, video conferencing, voice recording, or in-person by Heather Anayaya are for holistic, spiritual self-help and for informational and educational purposes only. Nothing herein is intended to, nor should it ever, take the place of any medical, legal, financial, psychological, or other professional advice. If expert advice or counseling is needed, the services of a competent professional should be sought.​ The advice and opinions offered by Heather Anayaya do not constitute a substitute for professional treatment, therapy, or other types of professional advice and intervention.

 

Heather Anayaya does not assume any responsibility for errors, omissions, or contrary interpretations of the subject matter herein by the client and will not be liable for any direct, indirect, consequential, special, exemplary, or other damages arising therefrom. Heather Anayaya, heatheranayaya.com, and Heather Anayaya: Reclaiming Wholeness YouTube channel assume no responsibility for any consequence relating directly or indirectly to any action or inaction you take based on the information, materials, or opinions on this website or communicated by email, telephone, video, video conferencing, in written format, recording, or in-person by Heather Anayaya. You agree to indemnify Heather Anayaya, heatheranayaya.com, Heather Anayaya: Reclaiming Wholeness YouTube channel, and its affiliates, members, managers, directors, officers, employees, agents, attorneys, contractors, and licensors against all claims, actions, suits, or other proceedings arising out of or incurred in connection with your use of the services, website, YouTube channel Heather Anayaya: Reclaiming Wholeness, in written format, voice or video recording, or a private or group sound and energy healing, meditation,  or channeled session.

Thank you for submitting!

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