NEW CLIENT SESSION FORM - REMOTE HEALING

Thank you for contacting William for your remote healing session. He looks forward to working with you soon.

All new clients are asked to take a moment and fill out the New Client Information, found below. This information is for William's record keeping only - your information is never shared with anyone and is kept confidential at all times.

Contact William at william@oneIAM.com with any questions.

In order to help you receive the most from your session, you may want to find a quiet place for your session in which you will be undisturbed. If this is your first remote healing session, please don't hesitate to ask any questions before the start of your session.

SESSION NOTES

Once you have completed the New Client Session Form, William will contact you to schedule a time for your remote healing session, if a time has not yet been set. Remote Healing Sessions last 30 minutes and it is not necessary for your to be in contact with William during your appointment. However, please plan to find a quiet place in which you may rest and observe your responses during your session. Following your appointment, William will be in contact with you via email to report his observations and the work that he completed.

Because you have contacted William for healing therapy, please list current health conditions and/or pain and emotional distress in the field below.

SUBMITTING PAYMENT: Payment for your Remote Healing Session may be made securely through this website. Once you submit this form, you will be taken to the confirmation page, through which you may submit payment. *You do not need a PayPal account to use this service. We accept credit and debit card only for Remote Healing Sessions, which must be paid in advance. If you prefer to make your payment over the telephone, William has a secure credit card machine in his office and can accept your credit card at any time before your appointment.

PLEASE READ AND CLICK "I AGREE" BELOW: I understand that the healing therapy given to me is not a substitute for medical or psychological diagnosis or treatment. I understand that absolutely no one affiliated with Xen Healing Arts, LLC, makes any guarantee that I will receive healing of my disease or conditions. I also understand that William does not diagnose conditions, nor does he prescribe or perform medical treatment, nor prescribe substances, nor interfere with the treatment of a licensed physician or licensed health care professional for any physical or psychological ailment I have. It is recommended that I see a licensed physician or appropriate professional for any physical or psychological ailment that I may have. I understand that this therapy can complement any medical or psychological care I may be receiving and affirm that well-rounded care, including holistic methods, is important to me. Energy healing causes no harm, therefore, I shall not hold Xen Healing Arts LLC, William Barnett, or any practitioners working at Xen Healing Arts liable or responsible in any way for my health condition, past, present, or future. I consent to the application of the bio-energetic holistic modalities presented to me, understanding that I may refuse treatment at any time. I shall now and always take full responsibility for my decisions and affirm that I am mentally and emotionally capable of intelligently making such decisions, as well as accepting or rejecting any and all suggestions or therapies. I further state that I have not been forced or coerced to accept any manner of treatment whatsoever from Xen Healing Arts LLC and anyone affiliated with Xen Healing Arts LLC and therefore, by signing this agreement, release Xen Healing Arts LLC and the therapists at Xen Healing Arts LLC from liability. I understand that if treatment is for a minor child (under 18), a parent or guardian must approve of this therapy for the minor involved.

PAYMENT FOR THERAPY - Payment for therapy is expected by the time of service. We accept Credit Card, Debit Card, Cash, and Personal Check. PRIVACY NOTICE: No information about any client will be discussed or shared with any third party without written permission of the client or the parent/guardian if the client is under age 18. I have read and understand the policies and privacy notice above (please indicate below).

Thank you for submitting your information online. When finished, click SUBMIT to send.