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Consent Form for Energy Work

Before working with Diane Vanas in an Energy Work session, please read carefully and then fill out, agree, and send the following intake-form:

1. I understand that Energy Work sessions, practiced by Diane Vanas, seek to identify and eliminate underlying bio-energetic imbalances. These methods of Energy Work promote harmony and balance within, relieving stress and supporting the body's natural ability to heal. Energy healing through these methods is recognized as a valuable and effective complement to conventional medical care.

2. I understand that the correction of energetic imbalances using methods practiced by Diane Vanas, 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 received is not intended to create any physician-patient relationship, nor should it be considered a replacement for consultation with a healthcare provider, nor is it meant to replace any medical treatments as ordered by any physicians or any other medical care I have been advised to seek by them. I further understand that these methods are not a replacement for any professional psycho-therapeutic or counseling sessions in the treatment of any mental health issues or disorders.

3. I understand that if any suggestions are made regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, or any compounds or any other external remedy of any kind, that I use or ingest any such at my own risk, with the recommendation that I seek the advice of a physician before using any remedy suggested by my practitioner.

4. I understand that Energy Work may occasionally result in "processing," where echoes of emotion(s) or other energy(s) released may manifest in temporary physical or emotional discomfort, and may be a part of the process of regaining energetic balance.

5. I understand that my practitioner makes no claims as to healing or recovery from any illness I may have now, nor the prevention of any illness I may have in the future, and that no guarantee is made towards validity. I further understand that the use of any information I receive is at my own risk.

6. I understand that if I have health concerns, I am recommended to seek advice from an appropriate medical practitioner before making any decisions about my health, and that this information is offered as a service and is not meant to replace any medical treatment.

7. I understand that these sessions are confidential.

8. I understand that by signing (agreeing to) this form, I fully consent to participating in Energy Work sessions with Diane Vanas (vibenergy's Natural Wellness).

Signed: (select "I agree" option in the drop-down box at the bottom below)____________________



Read the above Consent Form and fill out Intake-Form and hit "send" prior to session:









Date of Birth:

Spouse/Partner first name:

Please list any biological children with first names and their ages:

Family Situation (Single, Married, Separated, Divorced, Widowed, etc.)

Relationship issues:

Comments (medical history, surgery, illness, injuries, emotional traumas, etc. with approximate dates):

List and Rate: Top 3 stressors/concerns and/or areas of pain: rate the pain on a scale of 1-10 (10 being worst).

I agree to the terms of the Consent Form above and this constitutes my signature electronically.

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