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 Energy & Health Questionnaire

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Please fill out the following form to help me understand your healing goals. This must be completed before your session. Thank you 

Today's Date

By initialing this box, I acknowledge that releasing trapped emotions using Emotion Code, Body Code, or any other type of Energy work practiced by Monisha Flanigan, whether in person or by proxy, is not a substitute for medical care. This information is not intended as medical advice and should not be used for medical diagnosis or treatment. Information given to you on this site or in any session obtained on this site is not intended to create any physician-patient relationship, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.  Energy healing promotes harmony and balance within, relieving stress and supporting the body's natural ability to heal. Energy healing is widely recognized as a valuable and effective complement to conventional medical care.  **Side effects that may occur but are not limited to are: crying, vivid dreaming, intensity in emotions, tired, sick, out of sorts, immediate relief or lightness. I understand the potential side effects. All payments for services are non-refundable. Healing sessions are strictly confidential. Your personal information will never be shared with anyone. We make no claims as to healing or recovery from any illness. This information is offered as a service and is not meant to replace any medical treatment. No guarantee is made towards validity. Use this information at your own risk. I or my representative(s) agree to fully release and hold harmless Monisha Flanigan from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).  By viewing or using Monisha Flanigan's website, you consent in the event of a dispute or disagreement, to the exclusive jurisdiction and venue of a court of competent jurisdiction in Dunedin, FL and to the exclusive use of the laws of the State of Florida.

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Printable Release to bring before your session if coming in person.

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