New Client Form

Welcome!

To save time at your appointment, please complete this form before your first visit. Your responses will help me tailor the session to your needs and ensure your comfort and safety.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth

YYYY

Are you Pregnant?

(If yes, this may affect which crystals are used in your session to ensure your comfort and safety.)

Emergency Contact (Name & Phone)

(This is only used in the unlikely event of an emergency during your session.)

Do you have any physical restrictions or injuries?

(ankle, knee, hip, neck, shoulder, or other)

Any particular areas of concern?

Is there anything else you would like to share before our session?

Are you sensitive to fragrances from oils or incense?

How did you hear about my services?

Client Acknowledgement

I understand that Crystal Therapy involves gentle energy techniques, including the placement of crystals and gemstones on my body, guided meditation, and light touch. I acknowledge that it can assist in stress reduction, relaxation, and overall wellness, but it is not intended to replace medical, clinical, or psychological care. I understand that my health and wellbeing are ultimately my own responsibility during and after the session, and that the practitioner’s role is to hold a safe and supportive space for my healing journey.

Checkbox

I confirm I have read and understood the above Client Acknowledgement and consent to receive Crystal Therapy treatments from Lorijane Mahony.

Yes

IMPORTANT Disclaimer:

By booking and/or participating in energy healing services/workshops/courses with Lorijane, you acknowledge and agree as follows:

The material on this website is offered as educational information only. The author of this information does not dispense medical advice or prescribe the use of any technique as a form of treatment for physical, emotional, or medical problems without the advice of a physician, either directly or indirectly. No professional or mentorship advice is intended. In the event that you use any of the information on this website for yourself, the website owner assumes no responsibility for your actions. Please consult your physician or mental health provider if you are in need of health-related assistance on a physical or mental level. The website owner does not accept responsibility and is not liable in any way for your reliance upon or your use of the information contained on this website.

COPYRIGHT © 2025 LORIJANE MAHONY