Online Consent Form

Lasting Light Wellness Consent and Release Form

5305 Village Center Dr. Suite 205

Columbia, MD 21044

 (410) 446-2544


Hands-On In Person Energy Healing:
I, 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, nor 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 their 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.


If you are receiving hands on services, the diagrams below show where the Practitioner will be placing hands on you. 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 wanted touched. Let us know at any time during the service if there is something that needs adjusting or 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 us 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.


Late/Canceled Appointments
Out of respect and consideration your practitioner and other customers, please plan accordingly and be on time. If you are going to be late or are having problems the day of your appointment, please contact us at 410-446-2544, we will do our best to accommodate you. If you are late, we cannot guarantee a full appointment time, you may forfeit the portion of your appointment that you were late. 1st no show or cancelation in under 24 hours is charged a $35 fee per hour all subsequent no shows are charged the full session price, or one package session will be redeemed.


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.

Name (printed) client or legal guardian:

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