Andi Scarbrough - 2821 Pico Boulevard, Santa Monica, CA 90405 crownworks7@gmail.com

CROWNWORKS CLIENT INTAKE FORM

Andi Scarbrough, Founder www.crownworks.net I crownworks7@gmail.com
  • PERMISSION FOR SESSION: I give Andi Scarbrough and/of GetaDamnHaircut, INC: DBA CrownWorks permission to provide Reiki, energy healing, sound healing, and guidance work during our sessions. I allow the gentle “laying of the hands” during Reiki and other hands-on healing techniques. I understand this serive is a ritualized beauty treatment and may, in essence, change my phyical appearnace. I take full respsonibulity for the choices I make regarding style, length, and color of my hair.
  • I understand that services received from Andi Scarbrough and/of GetaDamnHaircut, INC: DBA CrownWorks are not a substitute or replacement of medical and/or psychological treatment by a physician for adults or minors. I understand that Andi Scarbrough does not diagnose medical and/or psychological issues. I recognize and understand she is not a licensed therapist, licensed grief counselor, child psychologist, pharmacist or medical provider. I understand all information provided between client and Andi Scarbrough and/of GetaDamnHaircut, INC: DBA CrownWorks is based solely on opinion. Additionally, I understand that neither Andi Scarbrough and/of GetaDamnHaircut, INC: DBA CrownWorks are responsible for any of my health issues or health related consequences, behaviors, actions, choices, moods, dispositions or emotional unbalances post-session, and that I (Client Name) am responsible for seeking medical advice and treatment/ intervention/ therapy/emergency care for self or psychological treatment and therapy as needed. PRIVACY: I understand session discussions and/or disclosures between myself and Andi Scarbrough and/of GetaDamnHaircut, INC: DBA CrownWorks are confidential. Information will not be discussed or shared with any third party without written consent of the client or parent/legal guardian if the client is under 18 years of age.
  • PERMISSION BY LEGAL GUARDIAN TO WORK WITH CHILD (CHILDREN): I give permission for my child (under age 18, please enter name) to receive Reiki, energy work, prayer, and guidance work by Andi Scarbrough and/of GetaDamnHaircut, INC: DBA CrownWorks I understand that I must remain present during the session, and that the confidentiality notice applies. I understand that I, as parent and legal guardian of child, am responsible for all medical, psychological, emergency care and academic decisions, and not Rae Patterson and/of Blue Sky Healing, LLC. *PLEASE ENTER PARENT NAME.
  • Andi Scarbrough and/of GetaDamnHaircut, INC: DBA CrownWorks has a 24 hour cancellation policy. If you cancel within the 24-hour period you will be charged a $50 fee. LATE POLICY: Andi Scarbrough upholds a late policy in order to respect all other client appointment times. In order to provide the best possible service to all, we ask that you arrive five minutes prior to your scheduled appointment time to center, ground and prepare your intentions for the coming session with Andi Scarbrough. Late arrivals will still be seen for the duration of the time window that was initially scheduled. PAYMENT POLICY: Andi Scarbrough and/of GetaDamnHaircut, INC: DBA CrownWorks asks that you pay for your session either prior to scheduled appointment or within twenty-four hours post session. Acceptable payments include cash, check, and credit card at time of service.