Dallisa Hocking

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Your Name *

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Yes, I understand that Service Providers at Spirit & Spark are not licensed, certified or registered as a provider of health care in any state or country. *

Yes, I understand.

It is recommended that before beginning any wellness plan, you notify your primary care physician or other licensed providers of health care of your intention to use wellness services, the nature of the wellness services to be provided and any wellness plan that may be utilized. It is also recommended that you ask your primary care physician or other licensed providers of health care about any potential drug interactions, side effects, risks or conflicts between any medications or treatments prescribed by your primary care physician or other licensed providers of health care and the wellness services you intend to receive. *

Yes, I understand.

Yes, I acknowledge that I can request a written copy of the statement outlined above, and I can request for it to be emailed to me, should I not be able to print it from this page. *

You can request a copy of the statement above by emailing dallisa@SpiritAndSpark.com

Yes, I acknowledge.

Yes, I understand that any of the services offered at Spirit & Spark are designed as a compliment to but not a replacement for appropriate medical care. I understand that nothing said, typed or produced by Spirit & Spark is intended or meant to diagnose, prescribe, treat a disease or take the place of a licensed physician, therapist nor will any practitioner prescribe medications or substances to me. *

Yes, I understand.

Yes, I understand that all Psychic Arts, Wellness Services and holistic energy healing forms used at Spirit & Spark are used for stress reduction, relaxation and to help promote optimization of my spiritual state, and none of which is massage. I will remain fully clothed, other than removing my shoes. *

Yes, I understand.

Yes, I understand that each form of energy work is different, and individual to me, and that my body may feel uncomfortable or unusual sensations such as tingling, minor heaviness, light pain or discomfort, heat, cold or other sensations. *

Yes, I understand.

Yes, I understand that none of the services at Spirit & Spark are sexual in nature, and the practitioner will not touch me in any sort of sexual manner, nor will sexual advances by me be tolerated toward any practitioner at Spirit & Spark. *

Yes, I understand.

Public Reading Agreement. *

Check the Box, Signaling You Agree To This: I understand that this is a public reading & anyone can hear my first name/last initial (and question, when applicable).

Yes, I understand that services provided at Spirit & Spark have no guarantees, and by law are for entertainment purposes only. *

Yes, I understand.

Yes, I have read and agree to the Privacy Statement. *

https://spiritandspark.com/privacy-statement

Yes, I have read and agree.

Yes, I have read and agree to the Terms of Use. *

https://spiritandspark.com/terms-of-use

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Electronic Signature of Your Parent or Guardian, if you are under the age of 18.

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