Hi there! Thank you for your interest in Biofeedback Therapy. Please fill out some information to help me better connect to and assist you! Before you get started, please read over these important details. 

Upon booking an appointment, an invoice will be created separately and sent to your phone number or email address that you provide in this form. The invoice will be from Square! If you do not receive an invoice within a business day after booking, please reach out and let me know as it sometimes fails to send. You may pay the invoice directly through the link it provides using CashApp or credit card. A 2.9% fee is added for all CashApp and CC transactions. To avoid fees, you may pay via Zelle to Haley Wright at 940-210-9743 or through Venmo to @Haley-Wright-114.

​All invoices are due 24 hours before appointment unless paying with cash in person. 

If you cancel your appointment,you must provide a minimum of 8 hours notice.
You will receive a full refund if 8 hours notice is given. You will receive a half refund if you do not allow an 8 hour notice. We prefer that any in-person session that is needing to be cancelled/rescheduled be performed remotely. This will keep you from forfeiting your payment.

 

Agreement for Services: Distance

The Distance services offered by Wright Direction Biofeedback are for biofeedback stress reduction. It is sometimes referred to as Vibrational Medicine or Energy Medicine. However, the services offered by Wright Direction Biofeedback are not connected with traditional medicine as practiced by most western medical doctors and hospitals. Traditional medicine is based on biochemistry. Quantum Biofeedback is concerned with biophysics and quantum physics. It is an entirely separate discipline concerned with the correction of energy fields and with balancing the bio-electric frequencies of the human system.

I agree to undergo Distance Sessions at my own risk. I further indemnify and hold harmless Wright Direction Biofeedback, Haley Wright, and/or their affiliates, as well as, any successors, assigns and executors, administrators, personal representatives, employees and heirs from any and all results of Distance Biofeedback or any other modality I receive from Haley Wright including The LIFE System biofeedback and/or any other energy instruments. All information discussed with your Biofeedback practitioner during your session is confidential.

This agreement shall be unlimited as to amount of duration, and it shall be binding upon and inure to the benefit of the parties, their successors, assigns, and personal agents and representatives.

Haley Wright does NOT diagnose, treat, prescribe or claim to cure any disease. Clients are advised that they should consult their own medical practitioners and medical professionals for the diagnoses, care, treatment, or cure of any health condition. However, it is the intent of Haley Wright to promote self-healing through information, stress reduction, biofeedback frequencies and emotional support. I understand that there are many kinds of energy frequencies that can include emotional, spiritual, and/or physical balancing. I understand that positive results are not bound by any particular time periods.

I am of legal age or have the consent of my parent or legal guardian to seek services of Haley Wright. I am of sound mind and able to make decisions about my own health. Signing the following concedes that: 1 have read and agree to the fore-going: 2 The procedure set forth above has been adequately explained to me by this provider. 3 I authorize and consent to the performance of the foregoing distance stress reduction services.

I would like to offer a few wellness suggestions in order that you have the best experience possible.

The Day of Your Session: It is recommended that you drink plenty of water both before and after your session. Please inform Haley, (Biofeedback practitioner) if you have a pacemaker or could be pregnant.

During your scan, (remote or in-person) it is suggested that you remove any excess jewelry, (outside of items you might wear on a daily basis). We also try to discourage the usage of your cell phone during the scan to prevent frequency interference.

If utilizing the Metaspace (remote) function, you may relax intentionally or continue on with your day as usual.

During your scan, you may feel subtle sensations as the frequencies are worked in your body. If you are highly sensitive to energies, you may feel stronger sensations.

Following your Biofeedback session, you may feel tired. This is natural because your body is freeing itself of stressors and regenerating. Allow yourself a nap or an early bedtime, if possible. To optimize your results, avoid alcohol or caffeine on the day of your therapy. It is also suggested that you decrease sugar intake the day of your scan.

 

 

I understand what I have read.