Empath Healing Session Form

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Tell me what's happening in your life right now. What's your biggest challenge?Please share as much or as little as feels right - I'm here to listen and understand your unique situation
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What would your ideal outcome look like when this is completely resolved? How would you feel? What would be different in your daily life?
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What's your main challenge?
Physical : Body discomfort, health concerns, fatigue, or physical imbalance
Emotional: Recurring patterns, relationship challenges, past trauma, or feeling stuck
Spiritual: Energy depletion, feeling scattered, disconnected, or needing realignment
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Which one do you want most?Pick the one that feels is priorty right now
Quick relief from specific issue
Help with diet and daily habits
Deep emotional healing
Ongoing support and transformation
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Would you prefer:
Distant healing (just receive energy remotely)
Online sessions (live video calls with me)
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What investment feels right for you so I can fit or create the perfect program?
One session ($70-111)
Short program ($133-222)
Monthly support ($400)
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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Include Country Code, e.g., +1 for USAInclude country code - optional for WhatsApp support)
Please enter a valid phone number.
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Date of Birth* This field is required.
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Address* This field is required.
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Afghanistan
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Montenegro
Montserrat
Morocco
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Myanmar
Nagorno-Karabakh
Namibia
Nauru
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Netherlands
Netherlands Antilles
New Caledonia
New Zealand
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Where did you hear us from?* This field is required.
Google Search
Facebook
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Referal
Other
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If you were referred, please let me know their name.
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Based on what you've shared above, I will recommend the best approach for your unique situation and needs.
Yes, please recommend the best approach for me
I'd prefer to see all service options first
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Which service are you most interested in?* This field is required.Is there a service you are drawn to? If not, that is ok, just tick not sure yet. Pick the one that feels is priorty right now
Medical Intuitive (Physical Codes) : Body discomfort, health concerns, fatigue, or physical imbalance
Inner Child (Emotional Codes): Recurring patterns, relationship challenges, past trauma, or feeling stuck
Energy Healing (Spiritual Codes): Energy depletion, feeling scattered, disconnected, or needing realignment
Other
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How much time and gentle effort feels realistic for your healing journey each week?* This field is required.This includes sessions, follow-ups and implementing techniques such as meditation or journaling in your own time
0-1 hours a week
1-4 hours a week
I will spend as much time as is needed
I do not have that much time
Other
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Do you have any questions for me?This can be at all levels of health: physical wellness, emotional, spiritual, purpose, abundance or other.
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Signature: Please sign here to acknowledge that the information provided is accurate and complete.* This field is required.Scope of Services and Medical Disclaimer: Megan Bailey is a medical intuitive and energy healing consultant, not a physician or psychologist. The services provided focus on wellness, prevention, and holistic support rather than the treatment or diagnosis of specific medical conditions. If you suspect you have an ailment or illness requiring medical attention, please consult a licensed physician. Only a licensed physician can prescribe medication, and any mention of drugs or supplements during consultations is solely for understanding your current regimen and not for evaluating the appropriateness of your medication. Decisions regarding prescription changes should always be made with your physician. Megan Bailey’s approach emphasizes non-toxic, natural nutritional therapies and energetic practices to support optimal health and prevent illness. The aim is to educate and motivate clients to take personal responsibility for their health through a positive attitude, lifestyle choices, and dietary practices. All advice provided should be considered at your own discretion. Discussions about health conditions during sessions are on an energetic level and should not be interpreted as a medical diagnosis. These sessions are not guaranteed to cure or prevent illness. While many clients experience improvements in health and well-being, Megan Bailey does not guarantee protection from future health issues. By signing below, you acknowledge that you understand Megan Bailey is not a medical doctor or psychologist. You agree to seek medical attention if needed and recognize that Megan Bailey will not be held liable for any failure to diagnose, treat, or prevent illness. Confidentiality and Disclosure: You have the right to confidential treatment, and your privacy will be maintained. Confidentiality will be upheld unless client consent is given, or if there is a clear and imminent danger to yourself or others, or as otherwise required by law. If there is any intention of self-harm or if you are experiencing suicidal thoughts, it is your responsibility to seek immediate help from a licensed mental health professional or appropriate support services. Megan Bailey will not provide mental health crisis intervention and is not liable for failure to address such issues. You are expected to disclose any intentions of self-harm so appropriate referrals can be made if necessary. Payment and Cancellation Policies: The consultation fee is due before the session. Cancellations made less than 24 hours before the appointment will incur a charge. Communication and Support: Megan Bailey is available for brief, general support between sessions but cannot offer comprehensive assistance via email or outside of scheduled sessions. Acknowledgement and Responsibility: By signing below, you confirm that you understand Megan Bailey’s role as a spiritual mentor and energy healer, not as a medical or psychological professional. You agree to seek medical advice if needed and acknowledge that Megan Bailey will not be liable for any health conditions or failures to diagnose or treat illness. You commit to providing accurate information about your medical conditions and medications and release Megan Bailey from responsibility for your individual response to the energies and information received. Program Participation and Refunds: Payment for sessions should be made at least 3 days in advance to secure your spot. Any session cancellations should be made with at least 24 hours’ notice to avoid charges. If joining a program or group coaching, you agree that it aligns with your goals. Refunds of 50% are available within the first week of participation; no refunds will be issued beyond this period.
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Consent* This field is required.By checking this box and submitting this form, I hereby consent to receive email communications and promotional materials from Shed and Shift at the email address provided above. I understand that I can unsubscribe from these communications at any time by following the instructions provided in the emails*This field is required.
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