Lasting Light Wellness Consent and Release Form

Lasting Light Wellness

Consent and Release Form

5305 Village Center Dr. Suite 205
Columbia, MD 21044
 (410) 442-6650


Hands-On In Person Energy Healing:
I or the minor guardian, the undersigned, understand many of the holistic healing techniques that we offer involve a natural "hands-on" method of energy balancing for the purpose of stress reduction and relaxation. I understand that a healing session is not a substitute for medical or psychological diagnosis and treatment. I understand that we do not diagnose conditions, prescribe substances, nor interfere with the treatment of a licensed medical professional. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I have. I understand that those under the age of consent require a parent or guardian to attend all sessions and to sign this form. I understand that payment of fees for services rendered is an acknowledgment of my satisfaction with the services provided.

When receiving in-person services the practitioner will use a combination of "hands-on" and "hands-off" as they work around your body. Private areas are done with hands floating. Tell your practitioner if there are any areas you do not want touched or if you want a no touch session. Let us know at any time during the service if there is something that needs adjusting, if you want to stop, be touched differently, or anything that we could do to make you more comfortable


All Energy Healing Services:
Although Energy Healing may have profound effects in individual cases, it is not considered medical in nature or a substitute for medical treatment. I understand that energy healing involves a natural method of energy balancing for the purpose of stress reduction and relaxation. I understand that energy healing does not diagnose conditions, prescribe, or perform medical treatments. I understand that energy healing does not take the place of medical or psychological care, and I have not been asked to stop conventional medical treatments.


Spiritual Guidance:
As a reverend and a shaman, we sometimes give spiritual guidance. Any guidance given is purely for spiritual development purposes. You hold Lasting Light Wellness harmless for any decisions you make based on this guidance.


Please tell your practitioner of any contagious foot conditions that you have. In the session we will work on your foot, toes, ankle and lower leg, the legs are sometimes gently swayed as well. Please let your practitioner know of any injuries or areas to avoid.


I or the minor guardian consent to participate in the process of hypnosis, with Lasting Light Wellness LLC. I understand that hypnosis can involve the use of techniques such as progressive relaxation, meditation, guided imagery, as well as other helpful methods.

I understand that clients vary greatly in their response to the hypnotic process, with some clients having powerful experiences and others experiencing relatively little. We cannot and will not predict outcomes or make decisions for you. I understand that no warranties have been extended and no specific outcomes have been guaranteed. I assume full responsibility for my actions and inactions which relate to any sessions.

Additionally, I am aware that the experiences during hypnosis may be a combination of real and/or imagined. I also understand that certain memories/experiences may invoke emotional reactions, they may be emotionally challenging for some clients. I understand that if at any time I become uncomfortable and/or unwilling to proceed with the hypnosis process, that I can request to stop the process and the hypnotic portion of the session will terminate. I understand that Hypnosis is not a replacement for medical treatment, psychological or psychiatric services or counseling. I also understand that the Hypnotist does not treat, prescribe, or diagnose any condition.

I grant permission for Lasting Light Wellness to record sessions. I understand that if there is any recording made of a session that it is for your personal use only and that it is not to be lent, copied, or sold under any circumstances. Do not listen to hypnotic material while driving, operating equipment or any other potentially hazardous situation. If you have a legal case pending, one in which you plan to testify. You should give statements or written testimony before doing any type of hypnosis that is related to that situation. It is not advised to do memory retrieval hypnosis for a situation that you plan to litigate. -- Please read and follow the hypnosis guidelines that have been sent to you so that you may have an optimal experience.


In Person Hypnosis:
I understand and give permission that during the session, my practitioner may gently touch me on the forehead, neck, shoulder, arm, hand, or wrist as part of a hypnotic technique.


Online Hypnosis
We are not responsible for inferior conditions on the client’s end such as noise, distractions, poor internet/phone connections, clients falling asleep etc. We are not required to refund or redo sessions for things that are out of our control on the client’s end. If a recording was requested and there were technical issues it is at our discretion to re-record, grant you access to similar material, or find another solution.


Cancelation/Late/Rescheduling Policy All Appointment Types:
No-shows, last-minute cancellations, or your request to stop/end mid-session will result in forfeiting the remainder of that session and the associated payment and/or single session package value. Fees cover the cost of the time taken out of our schedule which is reserved just for you. Payments are not in exchange for results. We cannot be responsible for the following occurring at the client's end: distractions, sleepiness, not being in the right state, being in an altered state and/or on substances, or for remote clients’ technical failures and noise from their environment. There is no charge for changes made at least 48 hours in advance. Between 24-48 hours there is a $35 per hour fee per hour of service change fee. For any other reasons simply contact us as soon as you know there is an issue.


All package/multiple session purchases are good for one year from the date of purchase. They may be redeemed at purchase price for items in our store or gifted to another with written notification. After a year all value will be forfeited.

Legal All Appointment Types:
Any disputes with Lasting Light Wellness LLC will be resolved by mediation only. The following is due to the modern version of dine and dash or receive services and then try to extort for leaving negative false reviews. If you have any issues with the service, it needs to be brought up before the service concludes. No remedy will be considered after your service has concluded. We will not grant refunds to anyone trying to extort us for posting false negative reviews. Lasting Light Wellness LLC will not testify on your behalf in a court of law. You grant us permission to contact you by email and text. Payment constitutes acceptance of all written terms.

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Document name: Lasting Light Wellness Consent and Release Form
lock iconUnique Document ID: 1f411e78cd63bcf68c2f774d0d874f64a9bc165e
Timestamp Audit
November 29, 2021 3:26 pm EDTLasting Light Wellness Consent and Release Form Uploaded by Kelly Neylan - IP