Psychoenergetic Healing Forms

Full Name*

Today's date*

Date

Age*

Tel no*

Occupation*

Are you currently taking any medication? (If yes, please specify)

Have you ever had psychiatric treatment? (If yes, please specify)

Have you any physical/medical conditions? (If yes, please specify)

Have you recently gained or lost weight?

Have you recently consulted your doctor?

Tick all items that indicate a problem to you :

Confidence

I would like to join Mindsynergy's mailing list and receive future updates on specials, prizes, and news*

NOYES

I agree that all of the information given by me is correct & true.

Signed*

Full Name *

Date*

Informed Consent: I, (full name and Surname)*

give Ilana Smidt permission to conduct a Psychoenergetic healing session for the reasons indicated on the consultation form.

What is Psychoenergetic Healing? As humans we all experience thoughts, feelings, behaviours, emotions. When there is a certain energy that charges these thoughts, feelings, memories and habits, it can create a "patterned" energy. The more charge, the bigger the energy. In psychological approaches, like talk therapy, counselling or behaviour therapy to name a few, there are effectively a change of the basic changes to these charged energies. While psychotherapeutic methods are effective, they very rarely target the energetic level directly.

Psychoenergetic healing sees the client as a whole being, including their body, mind, emotions and spirit, making up the whole human being. As human beings, we all have access to the Light for healing. It doesn't matter the belief system you follow, or what you want to call it. We all have access to heal ourselves. All that is needed is the willingness to do the inner work and to have a desire for further growth and healing. Commitment to growth is far more relevant than the nature of the problem for Psychoenergetic healing to be beneficial.

Psychoenergetic healing practitioners draws from an assortment of techniques to affect the mental and emotional energies. The practitioner goes directly to the source of the discomfort and the centre of the energy that created the discomfort. Although it may sound frightening to think of this direct approach, the experience is very healing, safe and effective approach to healing the presenting problem. Although it may cause brief discomfort in certain circumstances, it is soon replaced with an energetic shift and relief.

What Happens in a Typical Session?

The practitioner is guided by the individual's issue and need. Each session is a unique experience. There are elements of traditional "talking therapy" but most of the work is done in an altered state of consciousness called "Inner Space". The client experiences their multidimensional nature, guided by the therapist, the client becomes aware of colours, images, thoughts, memories, feelings, or physical sensations, such as pain, heat, weight, etc. "Inner Space" offers a range of experiences and can include the awareness of past lives and other dimensions. Using a "psychological x-ray technique" the client can become aware of the core issue and then observe the healing on an energetic level.

Remote sessions are done with the practitioner "Tuning in" to the client's energetic field and connecting to the their higher self for guidance. The same "psychological x-ray" technique is followed to effectively clear and release energetic blocks.

Psychoenergetic healing doesn't prescribe to a specific belief system and no prior experience of energy-based healing is necessary. As we are not always consciously aware of the subtle energies behind our behaviours, state of mind or emotional discomfort, Psychoenergetic healing can target those specific energies by releasing them and balancing them. Not releasing or balancing negative emotions, can manifest in the emotional body, causing further disturbances or even physical disease.

There is no promise or guarantee made for specific results or outcomes. The intention for each healing session however carries the intention for the highest good for each healing session and you will receive what you need to move forward on your life journey.

I have read and understood the information described above.

Signature*

Date*

Full Name*

Cancellation and refund policy

Understandably it is sometimes unavoidable to have to cancel or postpone a session. Please follow the guidelines set out below to ensure that all parties are protected

Payment for each session is taken in advance.

Sometimes it is unavoidable that you need to cancel or postpone a session. If for any reason you do need to cancel or postpone your session and you DO give me at least 24 hours notice then no payment will be due. Any payment taken in advance for this session will be used to pay for the next rescheduled session or refunded in full.

If you cancel your session with 12 - 23 hours notice, half of the session will be billed for and in the case of upfront payment you will be refunded only half of the session. Should you give no notice or cancel with less than 12 hours notice, full payment of the session will be billed for and no refund will be given if paid before cancellation.

Extreme circumstances such as an accident or illness will be considered.

Termination of treatment by me:

In exceptional cases where it becomes apparent that there is no progress, no commitment or participation on the part of the client, or repeated cancellations, I may terminate the course of treatment. If payment has been made in advance for any remaining sessions, these will be refunded in full.

Clients that are abusive or that are deemed to be threatening will have their sessions terminated or treatment refused and no refund will be given.

Termination of treatment by you:

You are completely free to terminate a course of therapy sessions at any time, although please be aware that in certain cases where a minimum amount of sessions are recommended, you will not receive the full benefit of what these sessions can offer to you.

In the case where you have paid upfront for sessions, the above cancellation policy apply and you will receive a full refund of sessions not claimed - i.e. if it is within the above cancellation policy. Alternatively, you can bank those sessions for future use - limited to 6 months banking. If the sessions are not cancelled or used before the 6 months are up, no refund will be given for these sessions.

Please call me on 071 175 3445 if you are running even a little bit late and leave a message if I am unable to answer. You can also send me a whatsapp or sms. If you do arrive late then you will simply get the rest of your allocated booking time unless I can accommodate a full session. This will depend on my commitments on the day. Payment will still be due for the full session booked for you.

At times I may unfortunately have to cancel or reschedule appointments, but it will only be if it is absolutely necessary and in extreme situations, such as illness or other circumstances beyond my control. I cannot always foresee events if booking clients in advance. Working so closely with people I sometimes however pick up illnesses such as colds and sore throats this means it would be unprofessional for me to practise and risk passing on. In such circumstances, I will try to give as much notice as possible and you will be offered the next available appointment suitable for you.

All precautions are made to ensure that you are safe during your session. Sanitation protocols will be adhered to. I will wear my mask during the session but will ask you to remove yours for your best experience in the session and breathing comfortably. Please consider that this is a risk that I am willing to take on and ask that if you experience any cold or flu like symptoms, to rather reschedule the appointment for when you feel better. I will follow this same protocol.

If you tested positive for Covid-19, please follow the guidelines of self-quarantine and reschedule your appointment or make the use of the online sessions.

Online sessions are offered for those unable to attend in person or if you prefer this to an in-person session.

Please note that individual results can vary and refunds for sessions already attended will NOT be actioned under any circumstances.

I, (full name and Surname *

understand the cancellation and refund policy and will adhere to the above.

Signature*

Date*

1. What is the reason for seeking Psychoenergetic Healing?*

2. Describe what you currently feel in relation to the difficulty you are facing?*

3. Using emotive words (e.g. frustration, guilt, worry, anxious, depressed, sad, angry etc.) describe the way you are feeling toward the difficulty you are facing?*

4. Do the following short exercise and describe what you are feeling and where you are feeling it in your body: Take a deep breath and close your eyes, think of this difficulty and notice any sensations in your body, any heaviness and/or any thoughts. Please write down your experience in as much detail as possible.*