Channeling/Healing Session Waiver

Channeling/Healing Session Waiver
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
I understand that Channeling/Healing Sessions may include the following:
1. Sound healing (singing, toning, didgeridoo)
2. Lifestyle coaching
3. Holistic Nutrition counseling/education
4. Spiritual Guidance
5. Distance energy work
6. Guided Meditation
7. Channeled Messages from Prime Creator
8. Light Language/Speaking in tongues
I agree to release Susie Beiler and the Creation Temple, from any liability associated with this session. I understand that I am taking personal responsibility my health by engaging in this session and that drinking water and eating pure food may help my body to release toxins and integrate the session work. I agree to inform Susie of any pertinent issues.

I accept any other modality used in my session/s and agree to release Susie Beiler and the Creation Temple from any liability associated with Channeling Sessions.

I agree to the terms outlined in this waiver.
Consent
Legal Capacity*

I hereby declare that I am at least 18 years of age fully quipped with my mental faculties and I am expressing my full consent and understanding in signing this waiver for the purpose of receiving this session.I am the representative signing this form on behalf of the patient. I am signing this instrument on his/her behalf with his/her full consent and authority that he be allowed to engage in this session.I am the legal guardian of the named patient. I am signing this waiver giving my consent for my child to engage in this session.
Signature of Patient

Clear
Name of Guardian/Representative

First NameLast Name
Signature of Guardian/Representative

Clear
Should be Empty:

Channeling/Healing Session Waiver

Consent