Client Intake & Consent Form

All our services will require completion of a client intake and consent form which will be sent to you by email, an example is below: 

Feather and Flame Holistic Services

Thank you for choosing Feather and Flame. This form helps us understand your needs and ensure our sessions are safe, respectful and effective. All information is confidential and treated with care in accordance with our Privacy Policy.

PERSONAL INFORMATION

Name: _________________________________________

Email Address: ___________________________________

Phone Number (optional): _________________________

Location/Time Zone: _____________________________

Preferred Pronouns: _____________________________

SERVICE INTEREST

Please tick the service(s) you are here for:

☐ Tarot Reading

☐ Reiki Healing

HEALTH & WELLBEING

This section helps tailor sessions appropriately. You only need to answer what you feel comfortable sharing.

1. Are you currently receiving support from a doctor, therapist, or other practitioner?
   ☐ Yes ☐ No
   If yes, please specify (optional):
   
   

2. Do you have any diagnosed mental health conditions you would like me to be aware of?
   ☐ Yes ☐ No ☐ Prefer not to say

3. Are there any topics or areas you do not want to explore during our work together (e.g., trauma, past lives, certain spiritual themes)?
   
   

SESSION AGREEMENT & CONSENT

Please read and tick to acknowledge each point:

☐ I understand that services offered by Feather and Flame are complementary in nature and are not a substitute for medical, psychological, or legal advice or treatment.

☐ I acknowledge that I am responsible for my own decisions, actions and wellbeing throughout and after the session(s).

☐ I understand that confidentiality will be maintained unless there is risk of harm to myself or others, in which case the practitioner may need to take appropriate action.

☐ I understand that I may stop a session at any time if I feel uncomfortable or overwhelmed.

☐ I understand that Reiki may involve energy work and Tarot involves intuitive interpretation, I approach these with an open mind and understand that outcomes are not guaranteed.

☐ I have read and agree to the Terms & Conditions, Refund Policy, Cancellation Policy and Privacy Policy provided by Feather and Flame.

☐ I give my consent to participate in sessions with Feather and Flame.

Signature: ___________________________

Date: ____________________

(If completing digitally, typing your name counts as your signature.)