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Client Intake Form
and Consent to Receive Services

How did you hear about The Fox Wellness Den?
Internet Search (ie: Google)
Social Media (ie: Instagram, YouTube)
Word of Mouth
Other
Have you ever had Reiki or other energy healing services before?
Yes
No
Are you comfortable with a light touch during a Reiki session?
Yes, I am comfortable with light touch.
No, I prefer a hands-off session.

Treatment Consent

I understand that services offered by practitioners at The Fox Wellness Den, including Reiki, somatic breathwork, sound healing, and other holistic services, are intended to provide relaxation and mental, emotional, and/or spiritual support and are not a substitute for medical or psychological care. Practitioners at The Fox Wellness Den do not diagnose illness, prescribe medications, or interfere with medical treatments provided by licensed healthcare professionals. It is recommended that I consult with licensed medical providers for any physical or psychological conditions. I agree that the practitioners at The Fox Wellness Den cannot be held liable for any problems that might arise that I think could be attributed to the energy healing or other services rendered. I have stated all my known medical conditions to my practitioner and, if necessary, I agree to keep my practitioner updated on my physical, mental, emotional, and spiritual health.


I acknowledge that these practices may complement my personal healing and wellness journey, and I understand that sustained benefits may require multiple sessions to support relaxation and the body’s potential to self-heal. I accept that these services are provided “as is,” with results that may vary and with no guarantee of outcomes. Periodically, my practitioner may provide links to other websites or written print material, which may be of value, interest and convenience to me. This does not constitute endorsement of material at those sites or any associated organization product of service. It is my responsibility to make my own informed decision about the accuracy of the information at those sites and print material, including their privacy policies. In no event shall The Fox Wellness Den or any of its practitioners be liable for any incident or consequential damages resulting from the use of the material.


My participation signifies my consent and understanding of these terms. My involvement is entirely voluntary, and the ultimate responsibility for my health and well-being rests with me. By participating in these sessions, I release The Fox Wellness Den and its practitioners from any and all claims of malpractice, non-disclosure, or lack of informed consent.

I acknowledge that I have read and agree to receive services according to the above terms.
Yes

PAYMENTS AND CANCELLATIONS

Cancellation and Appointment Changes:

Please contact The Fox Wellness Den promptly if you are unable to attend a scheduled appointment. If it's necessary for you to cancel or change your scheduled appointment, we require that you call at least 24 hours in advance.

 

To cancel an appointment please call 440-391-0223. If you reach the voicemail, please leave a detailed message. If you would like to reschedule your appointment, please be sure to leave your phone number and let us know the best time to return your call.

 

No-Show Policy:

A "no-show" is someone who fails to arrive for a scheduled appointment without calling The Fox Wellness Den at least 24-hours in advance to cancel. Late cancellations will be considered a "no-show".

 

If you are late for your appointment and haven't notified me, a courtesy call is given 10 minutes past your appointment time.  While we will try to accommodate the full session time, out of respect to other scheduled clients, accommodation may not always be possible. Your cooperation is appreciated.  If you have any questions, please do not hesitate to ask.

 

Cancellations and Refunds:

Cancellations made within 72 hours for any service appointment may receive a full refund (100%) or may reschedule for a future session with that session already paid in full.

 

Cancellations made within 48 hours for any service appointment may receive a half refund (50%).

 

NO refunds are given for cancellations within 24 hours of a scheduled appointment.

 

Exceptions will only be made in extraordinary circumstances. Emergency appointment cancellations and changes are handled on a case-by-case basis. In case of illness for either the client or the practitioner, you agree to reschedule the appointment with that session already paid in full to prevent the spread of illness to others.

 

No refunds will be given after a service has been performed.

 

How to Request a Training Refund or Transfer:

All refund requests must be submitted via email to TheFoxWellnessDen@gmail.com within 14 days of the scheduled service date. Email dates will be used to verify the timeframe. All refunds will be returned to your credit card or form of payment.

 

Other Service and Payment Information to Note:

Gift certificates never lose their value. However, after one year from the purchase date, there may be additional fees for the service if rates have increased. Please contact us to redeem your gift certificate; provide the certificate number and amount of time you'd like to book.

 

If you have poor internet service in your location, please choose a phone consultation to ensure a smooth experience. In the event of technical difficulties, we will try to accommodate the full session time, however out of respect to other scheduled clients, accommodation may not always be possible.

Date
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