New Client Form

Welcome!

Thank you for scheduling your first intuitive healing session. I’m honored to work with you. These sessions are rooted in the understanding that deep transformation occurs when the energetic body is cleared of patterns, blocks, and influences that no longer serve you. My approach integrates intuitive insight, divine guidance, and energy healing techniques. The intention is to help you return to your center, clearing blocks, and restoring clarity.

With gratitude,

Arlette Lapointe Certified Intuitive Energy Healer

First Name

Last Name

Email

Phone

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Address

Physical Address

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Address 2

City

State/Province

Zip/Postal Code

Country

Mailing Address

if different than physical address

Address 1

Address 2

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State/Province

Zip/Postal Code

Country

Emergency Contact Name

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Emergency Contact Phone

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Referred by Name

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Last Name

Current Occupation

Describe any issue(s) you wish to address

Are you/have you worked with a therapist (Psychologist/Social Worker)?

Yes

No

Option 3

Have you ever received an energy, reiki or spiritual healing?

No

Yes

Policies and Legal Agreements

CANCELLATION POLICY
Please provide a minimum of 24 hours’ notice of cancellation or rescheduling a session. Cancellations made with less than 24 hours’ notice will be considered a missed session and are not refundable or transferable. Exceptions ONLY at the discretion of the practitioner.

CONFIDENTIALITY POLICY
All personal information shared in sessions or on this form will be treated as strictly confidential and will not be disclosed to any third party without the client’s explicit consent, with the following exceptions:

Client Consent: Information may be shared if the client provides written or verbal permission to do so.
Professional Consultation: The practitioner may consult with senior practitioners or advisors solely for the purpose of providing the best support to the client. All such consultations will uphold strict confidentiality.
Legal Requirements: Confidentiality may be broken if required by law, including if there is imminent risk of harm to the client or others.

This work may involve emotional and energetic healing, but is not a substitute for licensed medical, psychological, or legal support. Clients are encouraged to seek appropriate care when needed.

LIABILITY DISCLAIMER
IN CONSIDERATION of my participation in any service or program, I, for myself and on behalf of my spouse, children, heirs, and legal representatives, hereby agree to the following:

I affirm that I am in good mental and physical health and capable of participating. I understand that healing may involve emotional and physical sensations, the activation of prior symptoms, and the release of stored trauma. I assume full responsibility for all outcomes.
I understand that if at any point the work is outside the scope of the practitioner’s expertise, I may be referred to a licensed medical or mental health professional.
I release and hold harmless Arlette A. Lapointe from any liability, claims, or damages that may arise from participation. I agree not to sue and to indemnify and defend against any such claims.
I affirm that I have read this agreement, understand its terms, and accept full responsibility for my participation.

IMPORTANT MEDICAL DISCLAIMER
The services provided by Arlette Lapointe are not intended to replace medical or psychological care. No diagnosis or treatment is being provided. Clients are encouraged to seek professional healthcare for any medical or psychological concerns.

Name

First Name

Last Name

Date

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By choosing the "I Consent" button below, I affirm that I have read and understand this document, including the policies, liability waiver, and disclaimer. I consent to participate in intuitive healing sessions and understand that this work is consultative and complementary to other care I may be receiving.

I consent

I do not consent