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First name
Last name
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Appointment Date & Time
What is your desired outcomes from this healing session?
I UNDERSTAND: Service is located in Valencia, Santa Clarita, CA. Address will be sent to me via email upon confirmation.
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Yes
No
I UNDERSTAND: I am arriving on time or 5 minutes before my scheduled appointment time.
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Yes
No
I UNDERSTAND: I am allowed to reschedule once with this deposit with at least 48 hours notice. After this period of time rescheduling will require a new deposit.
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Yes
No
I UNDERSTAND: My deposit will be forfeited for no-show.
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Yes
No
I UNDERSTAND: Cecilia Wong is not licensed to practice medicine in the state of California or any other state. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have.
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Yes
No
I UNDERSTAND: Information exchanged during a healing session is educational in nature and is intended to help me become more familiar and conscious of my own health status and is to be used at my own discretion. All client information and records are treated in a confidential manner.
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Yes
No
I UNDERSTAND: My session will last for the duration of the length of time booked. Hourly rate may apply to any additional time above the booked session.
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Yes
No
I give consent to receive hands-on healing from Cecilia Wong.
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