NEW CLIENT
INTAKE FORM

In order to participate in any of our offerings here at Waking Seed, we require all new guests to complete our intake form below to help us better serve you.

IN CASE OF EMERGENCY, WHO SHOULD WE CONTACT?

PLEASE PROVIDE A PHONE NUMBER WHERE WE MAY REACH YOUR EMERGENCY CONTACT

IS THIS YOUR FIRST VISIT WITH US?

YES

NO, I'M A RETURNING GUEST

HAVE YOU EXPERIENCED ALTERNATIVE NATURAL THERAPY OR ENERGETIC HEALING TREATMENT BEFORE? IF YES, PLEASE DESCRIBE.

ARE YOU CURRENTLY TAKING ANY MEDICATIONS OR HAVE ANY INJURIES, DISABILITIES, OR OTHER CONDITIONS WE SHOULD KNOW ABOUT?

WHAT IS YOUR GOAL FOR THIS SESSION?

PLEASE CHECK THE FOLLOWING BOXES TO CONFIRM YOUR AGREEMENT TO OUR TERMS OF SERVICE

Waking Seed holistic practitioners are trained and certified specialists who use safe, non-invasive energetic and traditional practices to balance the physical, emotional, and spiritual bodies, and nurture a healthy environment for overall wellness. I am well aware nothing performed, stated, implied, suggested, or otherwise communicated, whether written or orally, by Waking Seed, its officers, practitioners, agents, associates, representatives, and other authorized users is intended to diagnose, prescribe, treat, heal, or cure any medical condition, ailment, or disease, or in any way substitute professional medical care.

I agree to conduct myself in a respectful, safe, and appropriate manner at all times while upon the premises of Waking Seed and while otherwise interacting with Waking Seed and its practitioners, associates, representatives, and all other authorized users, and agree I will not participate in any services or offerings while under the influence of drugs or alcohol.

I understand all guests must be at least 18 years of age in order to receive or participate in any services or offerings provided by, at, or in association with Waking Seed, and any minor must be accompanied by a parent or legal guardian throughout the entire duration of services rendered.

I agree to treat Waking Seed and all property found therein with care and consideration, and understand I may be held financially and legally liable for the replacement or repair of any property lost, stolen, or damaged by me or my guests during my time at Waking Seed.

In consideration for receiving permission to participate in any events, activities, services, or offerings (collectively, "the Offering") provided or facilitated by Waking Seed, I voluntarily assume full and complete responsibility for myself (and my minor, if applicable) and any risks, both known and unknown to me, which may be connected with my participation. I hereby agree to release, waive, discharge, and covenant not to sue Waking Seed, its officers, practitioners, agents, associates, representatives, and other authorized users (collectively, the "Indemnified Parties"), under any circumstances (including negligence) for any and all claims, demands, actions and causes of action whatsoever arising out of or relating to any direct, indirect, incidental, or consequential loss or damage, personal injury (including death) or property damage of any kind I may incur or experience as a result of my participation in the Offering, or while upon the premises (or in transit to or from the premises), where the Offering is taking place. I further agree to indemnify, defend, and hold Waking Seed, and all aforementioned Indemnified Parties, harmless from and against any and all loss, cost, damage, liability, and expense (including, without limitation, legal and attourney fees, settlement costs, and other expenses) suffered or incurred by any of the Indemnified Parties arising out of, in connection with, or relating to my participation in the Offering. It is my express intent that this Release shall bind the members of my family and spouse, if I am alive, and my heirs, assigns, and personal representatives, if I am deceased, and shall be deemed as a Release, Waiver, Discharge, and Covenant Not to Sue the above named Indemnified Parties.

In submitting this Release, I acknowledge and declare: A. I have read the foregoing Release, understand it, and sign it voluntarily; B. All information I have provided in this form is true and correct; C. No oral representation or statements, apart from the foregoing written agreement, have been made; D. I am at least eighteen (18) years of age and fully competent; and E. I execute this Release for full, adequate, and complete consideration fully intending to be bound by the same.

PLEASE PROVIDE YOUR SIGNATURE HERE