Healing Room

Intake form and waiver

Please, select your level of family stress:
Please, select your level of work stress:
Please, select your level of relationship stress:
Please, select your level of health stress:

Consent Form and Waiver

Modalities: Reiki, Shamanic Healing, Emotional Freedom Technique, Energy Healing, Crystal Healing, BodyTalk, Shadow Work.  

 

I consent to treatment for myself (or my minor child) and understand that the services provided by Rosario Tate, The Healing Tribe and rosariotatehealingtribe.ca are intended to enhance relaxation and promote communication within my body.

I understand that these services are not a substitute for medical treatment or medications. I am aware that diagnosis is not given and medication is not prescribed. I'm aware I have to continue to have regular medical check-ups as part of my overall health care plan.

 

I understand that participation is voluntary and that at all times I may choose to end my participation.

I'm aware that during or after the services provided, the following may be experienced:

  • Deep relaxation and well-being; sleep or improved sleep patterns; feeling rejuvenated and re-energized.

  • A temporary healing reaction: feeling more fatigued; the experiencing of emotions and/or physical aches, even some that appeared long gone (re. physical pain from past injuries) lasting from 24 to 72 hours.

  • The disappearance of symptoms that were present prior to the session.

  • Personal insights about one’s life, memories of past events re-surfacing; a deeper sense of spiritual connection, and/or spiritual experiences that are out of the ordinary.

I understand that any information exchanged during any session is only informational in nature and is to be used at my own discretion. I also understand that any information imparted during these sessions is strictly confidential in nature and will not be shared with anyone without my written permission.

I understand that by providing this informed consent I am assuming full responsibility for my sessions and I hold harmless both Rosario, at rosariotatehealingtribe.ca and the facility/location where the services are provided.

I understand that there are no guarantees associated with these services, just as there are no guarantees in other health care modalities.

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