Indemnity Forms

The ALCHEMY MOVEMENT INDEMNITY FORM

SECTION I: PERSONAL INFORMATION
Please note all information is kept private and will never be shared.
(* denotes required fields)

* Indicates required field

Name *

First

Last

Date of Birth *

ID Number (South Africa only) *

Place of Birth *

Time of Birth *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Are you currently pregnant - if so how many weeks? *

Are you suffering from any known medical conditions, please state below? *

Are you currently taking any medications or have you recently taken any medications or received medical treatments? *

Yes No

Type of Medication or Medical treatment? *

Why would you like to book a session? Please supply a brief description. *

How did you hear about our services? *

Do you have any objections to my apprentice observing a session? *

No, I have no objection. Yes, I object and would prefer not.

AGREEMENT

Sessions, Courses and Ceremonies
The workshops, courses, ceremonies and individual sessions offered by me, Isa Ka Ra (Gisela Bean), are Shamanic and self-awareness practices serving the personal growth and development of my clients.
Shamanic energy work
Shamanic practitioners are not considered as recognised doctors, nor as healthcare practitioners or
therapists in the western legal and health care systems. Therefore I do not make any promises of healing. In
energy work the focus is not on illness or diagnoses, but on strengthening the conditions for health. Every
client is obliged to inform me in advance about current conventional medical therapies and treatments. I
reserve the right to refuse or terminate sessions on a case-by-case basis.
Personal responsibility
Clients take up my offers voluntarily and self-responsibly. Accordingly, clients can terminate their participation
in an event/session at any time - but without any claim for compensation.
Cancellation policy
Remote sessions can be cancelled free of charge up to 24 hours before the agreed appointment.
Sessions in my practice at The Alchemy Movement can be cancelled free of charge up to 24 hours before the agreed appointment.
Home visits and on-site appointments at the clients' place of residence can be cancelled free of charge up to 7 days before the agreed appointment. After that 50% of the price will be charged, up to 3
days before the agreed appointment 75% will be charged and in case of no-show the full price will be charged.
Payment
I offer the following payment options: Cash payment, PayPal or bank transfer. Payment must be made before attending the session. Payment confirmation will be issued (electronically) once payment is received.

By signing this document, I confirm that I have read, fully understood and agree with the information in this
document. I accept and agree to the terms and provisions contained in this agreement.

Name in Full *

Date *

Submit

The ​ALCHEMY MOVEMENT INDEMNITY FORM

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The ALCHEMY MOVEMENT INDEMNITY FORM