New Client Registration Form
Spiritually Aligned with Asiya
Full Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Format: (000) 000-0000.
E-mail
Preferred method of contact to schedule:
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Phone Call
Text
Email
Preferred method of payment:
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Venmo (asiyajaved) * Preferred by Asiya*
Paypal (j_asiya@hotmail.com)
Credit Card (Invoice will be sent)
Please choose the programs you're interested in:
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1:1 Spiritual Guidance
Kundalini Yoga & Meditation
Subtle Body Energy Healing
40 Day Program - Journey Home
90 Day Program - Be Your Own Beloved
Tea Ceremonies
Tea and Healing combo offerings
Preferred Location:
Virtual in Zoom-land
In-person at Asiya's home studio space
Hybrid
Please add anything additional you would like for me to be aware of:
Example: medications, mental or physical health conditions, etc. For 1:1 Guidance and 40 day programs we will go over everything in details during our initial intake or a form will be sent prior to our first session.
I understand that practicing yoga and meditation is often about exploring new boundaries and personal limitations. I recognize that activities of this nature involve an element of physical,emotional, and psychological risk. I understand that each person’s level of physical and psychological fitness is different, and that some activities may not be appropriate for me given my individual capacities. I accept the need to monitor my own participation in each activity, and each exercise within any given activity, and that Asiya is not responsible for any physical and psychological risk I choose to take in my education, exploration, and inquiry.It is my responsibility to honor my physical and psychological boundaries, and if I feel unsafe in any way, I may stop participating in an experience and consult with Asiya.
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I understand that Asiya Javed is not a licensed physician, psychologist, or medical practitioner of any kind and that Energy Healing / Reiki should not be considered a replacement for the advice and/or services of a psychiatrist, psychologist, psychotherapist, physician, or doctor.
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We understand that unexpected situations arise, and you may need to reschedule or cancel a session. However, to receive a credit or refund for a paid session, a minimum of 24-hour notice is required. If cancellation occurs within less than 24 hours, no refund or credit will be issued.If the session is scheduled but has not yet been paid for, the client will still be responsible for payment of the full session fee.
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By signing this, you acknowledge the following: To the best of your knowledge, all the information provided is true and correct. You have disclosed all medical particulars. Please note that by agreeing to these terms and conditions and entering into this agreement, you accept that Asiya Javed will in no way be liable and/or responsible for any current and/or future medical conditions that you may have and all information and advice given is with your best interests at heart. As a spiritual coach, Asiya respects and adheres to client confidentiality and privacy. Should there be changes to any of your personal information and health status, please notify me.
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Date
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