Laura Naomi
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Gestalt Therapy Form

    Gestalt Therapy Questionnaire

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  • Before submitting this form, please read the Client Agreement and Release Form below.
  • By clicking the 'Submit' button you are agreeing to the terms and conditions listed below.
  • All information is confidential
  • If you have any questions about the Term and Conditions and Client Agreement Form below, please don't hesitate to reach out to us: CONTACT
Conditions, Client Agreement & Release Form

Laura Naomi offers the services of energy healing (including spiritual guidance, space clearing, energy clearing, cleansing chakras/aura, shamanic healing, sound healing, kundalini healing, Gestalt therapy and trauma-informed yoga) to assist and guide the client with spiritual wellbeing and wellness. By filling out the Client Form you are agreeing to these services and Laura Naomi as your guide in energy healing sessions and these healings are not a substitute for medical advise, nor should these session replace advise from your professional health-care provider. 

I, the undersigned, agree that I am a voluntary participant in energy healing consultations and sessions offered by Laura Naomi and that I accept and pay for those services and results are not guaranteed.  I reserve the right to refuse or withdraw participation. I agree to provide at least 24 hours notice of any cancellation. Notice shall be given via email, CONTACT or by the phone number provided.
 

If I do not give 24 hours notice, I understand that I will pay for the session in full.
 
I understand the energy healing offerings are designed to empower individuals to achieve spiritual and emotional wellbeing and may include, but will not limited to:
  • Energy clearing; chakras and auric system dealing with past, current or future issues
  • Tailored and specific recommendations and guidance to support you and your body through the changes and/or transformation process
  • Kundalini Meditation, Breathwork and healing methods
  • Gestalt methodology and processes
  • Emotional/spiritual guidance and support
  • Trauma-informed Yoga (Yoga Alliance approved)
  • Support overcoming personal challenges and self-sabotaging behavior or spiritual crisis (referrals to other suitable professionals may be given)
  • Shamanic healing processes
  • Providing support may also include referrals to professional medical practitioners or group therapy

The guidance offered under this Agreement is acknowledged and understood to be of a strictly non-medical nature. Based on initial assessment of spiritual, emotional conditions and medical history, on occasion, Laura Naomi may decide to forego or cease energy healing consultations with a client. Recommendations of other specialists or providers may be offered. The clients best interests, safety, confidentiality and comfort are of utmost importance.
The offerings provided by Laura Naomi do not provide medical treatments, cure, treat or diagnose any disease or condition. The consultations and sessions are designed for and restricted to energy healing, spiritual, emotional wellbeing and support. Laura Naomi's intent is not to replace any relationship that exists, or should exist between you and your Medical Provider or Mental Health Provider. The consultations do not involve the diagnosing, prognosticating, treatment, or prescribing of remedies for treatment of disease.
 

If I am under the care of a physician for a medical condition or taking prescription drugs, I am responsible for informing Laura Naomi about those and for ensuring that any recommendations given by Laura Naomi are not restricted by my physician. If I arrive to my appointment under the influence of illicit drugs or alcohol, Laura Naomi has the right to refuse me. I understand that I will be liable for 50% of the consultation fee.

For more information for all visitors (including patrons, customers or visitors of the EU or Switzerland) on the Terms & Conditions, Privacy Policy and Disclaimer of this Website "www.Laura-Naomi.com", please refer to the "Terms & Conditions, Privacy Policy, Disclaimer" page.
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  • The Healing Space
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