Client Intake Form

    Clear Path Energy Healing
    Mary L. Benner, MA, EEM-AP

    Basic Information

    Employment Information

    Emergency Contact

    Please Read Carefully Before Submitting

    I understand that the energy healing sessions I receive are provided for the basic purpose of harmonizing my body’s energies. If I experience any pain or discomfort during a session, I will immediately inform my practitioner.

    I further understand that energy healing should not be construed as a substitute for needed medical attention. Energy healing practitioners do not diagnose, treat, or prescribe for medical conditions. Energy healing brings about physical improvements by impacting the electromagnetic fields that regulate the body as well as by shifting the more subtle energies described in other cultures with terms such as chakras, meridians, and etheric fields.

    By electronically signing and submitting this form, I agree to share this information with Clear Path Energy.