Who Knew Healing LLC
New Animal Intake Form
Owner Name
*
First Name
Last Name
Second Owner Name if applicable
First Name
Last Name
Animal Name
*
First Name
Last Name
Animal Type
*
Animal Breed
*
Animal Age
*
Animal Sex
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Accept Text?
*
Yes
No
Email address
*
example@example.com
Reason for session:
*
How did you hear about us?
*
Would you like to be added to my email list? I will not overload you with emails I promise!
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Yes
No
I understand my animal does not need to be with me for the session. And I will be in a quiet place without disruptions during the session.
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I understand
I understand that animals communicate better with specific questions. I will have my questions prepared beforehand. And I will do my best to have them be as specific as possible.
*
I understand
If you want your session to be recorded, please use a computer. Recording is not supported on phones or other mobile devices. The recording will be saved directly to your computer.
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I understand
I state that I will respect boundaries and all communication will be during office hours. I understand that office hours are 9am-6pm (MST) Monday through Friday.
*
I understand and agree
There is a $50 fee for cancellations or no shows with less than 24 hours' notice. Appointment hours are 10am-5pm (MST) M-F. Office hours are 9am-6pm (MST)M-F.
*
I understand and agree
I understand Alicia Sweezer is not a medical doctor and does not practice medicine. She does not diagnose, heal, cure, prevent, prescribe, or perform medical treatments, prescribe substances, treat disease, or interfere with the treatment of a license medical professional. She assists animals in correcting energetic imbalances that enables the body to release its innate healing ability. When the energy of the body is balanced and moving correctly, the body’s own energy heals itself. All the healing is self-healing. I understand energy work is not a substitute for any medical diagnosis or treatment. I understand it is recommended that my animal see a licensed health care professional for any physical or psychological issues they may have. I understand energy work can complement any health care they may be receiving. I understand Alicia Sweezer doesn’t make any promises, warranties, or guarantees about the results of her work. I give my consent for Alicia Sweezer to touch my animal’s body for the benefit of releasing that which limits them in areas of their life they want to change. I understand this is NOT therapy or medical treatment. I have had the opportunity to ask Alicia Sweezer questions re: this process and feel comfortable in the information I have received. Except in the case of gross negligence, I or my representative(s) agree to full release and hold harmless Alicia Sweezer from and against any and all claims of liability of whatsoever kind of nature arising out of or in connection with these session(s).
*
I agree
Please upload a picture of your animal. Just one that shows their face and makes you smile.
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Date
*
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