Client/ Appointment Forms

Serenity's Light L.L.C.- Integrated Therapies

All Healing Comes from Within

                                             Treatment Contract:

This agreement is between Lucy Schwill hereinafter referred to as hypnotist and energy worker and ____________________, hereinafter referred to as client.

I (the client) understand that Lucy Schwill is not a psychotherapist and as such does not diagnose or treat disease, rather supports lifestyle and health.

I (the client) hereby agree and request to receive the work indicated below understanding that the work is potentially powerful mentally and physically and can be a regulating tool. I understand that personal results will vary and that there are no expressed or implied guarantees/warranties of result.

I ( the client) am fully informed of the nature and usefulness of hypnosis &/or energy work. Further, I am aware that this program is non-medical and I will consult my health practitioner for any changes in medication.

I (the client) understand that information provided on the relationship between the mind-body connection and health is not meant to replace competent medical care treatment for any health problem or condition. Health education and medical care are complementary and integrative, when properly delivered.

I (the client) choose to improve my health by assuming greater self-responsibility to reduce or eliminate unhealthy behaviors that are contrary to it.

I agree to arrive on time knowing that appointments may not be extended due to scheduling of other clients. (Full payment is still expected of a client that arrives late.) I agree to abide by Serenity's Light L.L.C. appointment cancellation policy. I will give 24 hrs. notice by phone or email for appointments that can not be met. I agree to pay a $30.00 cancellation fee per incident for failure to follow procedures.

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Client Signature  (day of appointment)                          Date (day of appointment)

Scheduling an Appointment
1. Fill out confidential client information below and make a payment choice. (This is a secure site, so all information is secure.)
2. Make a payment choice in the information section. Then if payment is being made by PayPal, press button for payment and follow PayPals directions.
3. I will email back to you a scheduled appointment.

Confidential Client Information

First Name:
Last Name:
Street Address and zip code:
Home Phone Number:
Work or Cell phone number:
Email address:
Date of Birth::
Marital Status::
Parents living/deceased:
Occupation:
What is your main concern?:
Other concerns (physical, mental, emotional, or spiritual):
What is your religion or faith?:
Describe any health problems I should be aware of::
Medication:
Surgeries::
Family Dr. & Phone Number:
Recreational Drug use; if yes please explain.:
Have you worked with other natural healing alternatives? If yes, please name::
Experience with Hypnosis or meditation::
How did you hear about Lucy Schwill?:
Hypnosis $120.00 ( 1 hr. session) $15.00 for each additional 15 minutes
Phone Deeksha $30.00 1/2 hr. session:
Energy work $65.00 per 1 hour session:
Integrated Therapies $120.00 1 1/2. hr session
Reiki Class Level I : $150.00
Reiki Class Level II: $150.00
Date available for appointment
Time available for appointment (First Choice)
Time available for appointment (Second Choice):
Payment by cash or check, day of appointment
Payment by Pay Pal prior to appointment

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