Initial Consultation Form

To help me to prepare for our consultation, please fill out these forms.

Please fill out the fields below. This information helps me to tailor your experience.

Step 1 of 3 - Contact Information

Name*
First Last
Home Phone*
Cell Phone (Or Evening Phone)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email (optional)
Emergency Contact

Name of Service and/or Event*
Consent*
I agree to the privacy policy.
I understand that Soul Light Healing does not diagnose conditions, nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Soul Light Healing does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that Soul Light Healing can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.

Privacy Notice:
No information about any client will be discussed or shared with any third party without written consent of the client or parent/guardian if the client is under 18.
Consent*
I agree to the service waiver.
I acknowledge that I am attending an event that has been set up by Master Mary Anne Melvin of my own volition; and that as an event attendee, I voluntarily choose to participate in and partake of event activities, teachings and offerings, including receiving spiritual healing and blessing services offered by Master Mary Anne Melvin, a Master Teacher and Worldwide Representative of Dr. and Master Zhi Gang Sha and, the Tao Academy. As part of the event I hereby affirm my will and consent to receive the spiritual blessings offered in this service. Specifically, I acknowledge the following:

As a Master Teacher,Master Mary Anne Melvin offers Divine Blessings,which carry divine love,light,forgiveness and compassion. These spiritual blessings come from the Soul World to assist in the removal of energetic and/or spiritual blockages in the physical, emotional, mind and/or soul bodies of the recipient. They can be offered in person or remotely, over the telephone, without touching, in a office setting or at an event, or through products or other services, all of which may be offered at the event.

I acknowledge the event activities can be strenuous and may cause physical reactions in some people. I am solely responsible for and prepared to handle any pre-existing medical conditions. Furthermore, if I should require or desire emergency or professional medical attention, I am responsible for all costs associated with my care. I release Master Mary Anne Melvin of any liability associated with any illness or injury, physical or otherwise, that may result from my participation in this event or receiving Soul Healing Services. Divine Blessings offered by Master Mary Anne Melvin are not a substitute for conventional medical diagnosis or treatment for any medical or psychological condition. For such issues, I will seek the help of a licensed physician or other health care professional.

I understand that there is no promise, guarantee or other warranty of any results from receiving any Divine Blessing service. Past recipients have experienced a range of outcomes, from no tangible improvement, to some improvement, to significant improvement. Always consult your medical professional regarding any medical condition and before receiving any divine healing or blessing. Advance consultation with your physician is advised and particularly important if you are older, pregnant, nursing or have health problems.

Iacknowledgethatallphysicalandelectronicmaterialsrelatedtotheservices,products,teachings and blessings offered by and through Master Mary Anne Melvin are proprietary,reserved and/or copyrighted intellectual property by Dr. and Master Sha and Tao Academy. These materials include,but are not limited to,books,CDs,DVDs, digital audio and video media and content,text in publications other than books,text on websites,photographs,other images and other design elements.

Therefore, I acknowledge that they cannot be made, reproduced or disseminated for any commercial or other purposes outside of the work of the Tao Academy and other organizations and affiliates of Master Zhi Gang Sha without express written consent and authorization, whether such consent and authorization are freely given or are through a licensing agreement.

INCONSIDERATION OF BEING ALLOWED TO ATTEND AND PARTICIPATE IN THE EVENT,I HERE BY AGREE TO WAIVE AND RELEASE ANY AND ALL CLAIMS FOR DAMAGES, INJURY OR LOSS OR OTHER LIABILITY RELATED TO MY ATTENDANCE AND PARTICIPATION IN THE EVENT AND OR SERVICES AGAINST MASTER MARY ANNE MELVIN,I AGREE THAT MY RESOLUTION IS TO LIMIT OR DISCONTINUE MY PARTICIPATION AND ATTENDANCE OF THE EVENT AND OR SERVICES, ALL OF WHICH I UNDERSTAND IS MY VOLUNTARY CHOICE.

The foregoing applies to the event and/or services for which it is signed. My participation in the event and/or services offered was not solicited by Master Mary Anne Melvin, and the Soul Light Healing or other volunteers of any event or services.
Phone
This field is for validation purposes and should be left unchanged.