Wellness Consultation Form.
( For a child session, please answer what you feel your child would say, you don't have to ask your child the questions unless you want to.)
Please click on the questions below, enter your answer (the more detail the better), then send after completing the questions!
Please pay HERE if you have not already paid for the session. Payment is due before the session. Click on the $0.00 and enter the amount due to be sent to paypal. Thank you!
All sessions, consultations, or resources Wendy provides is for informational purposes only and is not a treatment plan or recommendations. You are responsible for your own healthcare. Please seek out a licensed medical professional for all medical, mental health, or nutritional needs.
Wendy Beers is not a Doctor, Counselor, Homeopath, or Nutritionist. The sessions/consultations she provides is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be used as a substitute for professional diagnosis and treatment. Please consult your healthcare provider before making any healthcare decisions or for guidance about specific medical or mental health conditions. Wendy Beers expressly disclaims responsibility, and shall have no liability, for any damages, loss, injury, or liability whatsoever suffered because of your reliance on the resources, information, sessions, or consultations she provides, any treatments you decide to use, any use of any remedies from Source Homeopathy Pharmacy, or any other place of use of any type of natural remedies. The session or information with Wendy Beers is not counseling nor should any person seeking such or who may need professional mental health care assume that this service will provide counseling or mental health care. If you are seeking mental or medical health care, please seek out a health care provider in your area.
I give Wendy Beers permission to work with me and/or my child during the consultation(s)/session(s).
Electronic Signature (E-Signature): I consent and agree that your use of a keypad, mouse or other device to select an item, button, icon or similar act/action while using any electronic service we offer; or in accessing or making any transactions regarding any document, agreement, acknowledgement, consent, term, disclosure, or condition constitutes your signature, acceptance and agreement as if signed by you in writing. Further, you agree that no certification authority or other third-party verification is necessary to validate your electronic signature; and that the lack of such certification or third-party verification will not in any way affect the enforce-ability of your signature or resulting contract between you and Wendy Beers. You understand and agree that your e Signature executed in conjunction with the electronic submission of your application will be legally binding and such transaction will be considered authorized by you.