getting to know you

this form is a space for you to share a little about yourself and what you're currently moving through. it helps me get to know you better and prepare for our session with more intention and care.

there’s no right or wrong way to fill it out — feel free to answer in your own words, with whatever feels true for you right now.

everything you share is confidential and used only to support your healing journey.

full name

date of birth

YYYY

phone number

city you currently reside

is this your first experience with holistic therapy?

yes

if not, please tell me a bit about your experience.

do you have any medical conditions you would like to share with me prior to our session?

yes

if yes, please tell me more about it.

is there any specific reason for booking this session?

are there any specific areas of your physical, emotional or mental well-being that you would like to address?

how are you hoping to feel after this session?

terms & conditions

Complementary Therapy I understand that Reiki, Crystal Therapy, Chakra Alignment, Yoga Nidra, and Breathwork are complementary therapies and may have both desirable and undesirable effects. These may include emotional release, physical sensations, sensitivities, or adjustments in habits and lifestyle. I acknowledge that these practices are not a substitute for medical care. If I have any specific health conditions — including but not limited to pregnancy, heart issues, respiratory conditions, or a history of trauma — I have informed Leticia Sarosdi via email before my treatment. If I am pregnant, I have notified Leticia Sarosdi that I am expecting and shared how far along I am, so the session can be adapted accordingly and safely. Professional Notice I acknowledge that Leticia Sarosdi is not a licensed medical professional and does not provide diagnoses or prescribe medications. Any conversations about health and well-being are for informational purposes only and should not replace the guidance of qualified healthcare providers. Privacy Policy I understand that all sessions and any information shared before, during, or after will be treated with confidentiality. Leticia Sarosdi will securely store my personal information and session notes and will not share them with third parties without my prior consent. Payment Policy I understand that payment is required at the time of booking. This supports the commitment to the process and honors the energetic preparation involved. Healing can bring up resistance — this structure encourages follow-through even when that happens. Cancellation Policy I understand that a minimum of 24 hours’ notice is required to cancel or reschedule a session. If I cancel within less than 24 hours or do not attend my session, I acknowledge that no refund will be given. If I am using a session package, one session will be deducted as a cancellation fee. Your Commitment I understand that I am responsible for my own well-being, decisions, and the integration of any insights that may arise from our sessions. I accept full responsibility for my progress and results, and for any actions I choose to take as a result of our work together. I agree to avoid alcohol or any mind-altering substances for at least 24 hours prior to my session. I understand that if I arrive under the influence, the session will be canceled and no refund will be provided. (This does not apply to prescribed medications.)

I have read and understood the information on this consent form. All information I have provided is true and correct. I consent to receiving holistic therapy treatments from Leticia Sarosdi.