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  •  Service Terms and Conditions 

    All service recipients must meet the requirements below :

    General :

    • All service requests are subject to approval.
    • Each appointment is for 1 person only. 
    • Indivituals under 18 years of age must be accompanied by a guardian.
    • Female must be in Hijab & be accompanied by a mahram.

    Prerequisites:

    • Submit the Client form prior to requesting appointment.
    • Review and agree to service Terms, Conditions, Consent and Waivers.

    Appointment:

    • Clients must submit a request for a service appointment and receive confirmation.
    • Cancellation permitted 72 hours prior to appointment without penalty.
    • Cancellations under 72 and before 24 hours prior to appointment will incur a fee of $25.00
    • Changes under 24 hours are not allowed
    • No Shows will incur a fee of 100% of the service price.
    • Late arrivals will result in shortened sessions.  

  • Identification

  • Format: (000) 000-0000.

  • Part A: Background

  • Q.A6) Do you wear or have amulets (taweez), charms, or have talisman at home for good luck, prosperity, protection, etc?
  • Q.A7) Are you or member of your family involved with spiritual occult practices ?
  • Q.A8) Is any of your family member afflicted or diagnosed with magic or Jinn possession?

  • Part B: Faith & Practice

  • Q.B1) Do you observe the five daily prayers?
  • Q.B2) Do you recite Quran everyday?
  • Q.B3) Do you recite your morning & Evening Azkar?
  • Q.B4) Do you dislike water or making ablution for prayer?
  • Q.B5) Do you dislike hearing to Azan / Quran?
  • Q.B6) When listening to Quran, do you feel uncomfortable, something moving in body, throat, stomach, feel like crying / tremble and want to stop listening ?
  • Q.B7) Do you avoid acts of worship and obedience, remembrance of Allah and reading the Quran?
  • Q.B8) Do you constantly forget to say Bismillah before eating or drinking?
  • Q.B9) Are you unable to focus in prayer?, Always in a haste to complete prayer and constantly forgetting words or how many rakah’s have been performed ?
  • Q.B10) Do you have muscle spasm / cramp during prayer?
  • Q.B11) Do you like listening to music?
  • Q.B12) Are you involved in usury ( interest )?
  • Q.B13) Are you involved in any major sin?

  • Part C: Psychological (During Day/Work Time)

  • Q.C1) Feeling
  • Q.C2) Mental
  • Q.C3) Nervous

  • Psychological (During Night / Sleep Time)

  • Q.C4) Sleeplessness / Insomnia
  • Q.C5) Dreams & Sleep

  • Part D : Physiological

  • Q.D1) Feeling
  • Q.D2) Pain
  • Q.D3) General

  • Part E : Relational & Behavior

  • Q.E1) Check all symptoms that apply.
  • Q.E2) Addiction

  • During Night/Sleep Time

  • Q.E3) Check all symptoms the apply

  • For Married - Behavior with Spouse

  • Q.E4) Check all symptoms the apply.

  • Part F : Material Affairs

  • Part G : Details

  • CONSENT FOR RUQYAH SERVICE

    Purpose of Service
    Ruqyah is a spiritual practice based on recitation of Qur’an and supplications. It is offered for spiritual support and should not be understood as medical treatment. Ruqyah practitioners at EPIC Ruqyah Center are not medical professionals, and this service does not replace medical care from a licensed doctor.

    What to Expect
    During a Ruqyah session, the practitioner may:

    Recite Qur’an and supplications
    Blow air or lightly touch (with consent)
    Offer general spiritual advice
    Suggest use of items commonly known in Islamic tradition (e.g., certain oils, water, or herbs)
    Any physical remedies (such as massage, cupping, or acupressure) are not part of this service and, if ever mentioned, are considered optional faith-based practices outside the scope of EPIC Ruqyah Center.

    No Guarantee
    There is no guarantee of specific results. Ruqyah is a form of spiritual help, and outcomes are in the hands of Allah.

    Privacy
    We respect your privacy. Information you share will be kept confidential and used only for providing Ruqyah services. We will not release your personal information to others without your permission, unless required by law.

    Payment
    I understand that I am responsible for payment of services received, unless other arrangements have been made in advance.

    Consent
    I confirm that I have read and understood this form. I consent to receive Ruqyah services for myself and/or my child(ren), knowing that this is a spiritual practice and not a substitute for medical treatment.

  • INTERNAL

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  • INT-DIAG
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