RELEASE AND CONFIDENTIALITY AGREEMENT Heather Healing & Heather Swift

I, _________________________________, enter into this Agreement with Heather Swift of Heather Healing to confirm in this Agreement the conditions of my participation in the reading and or energy session to be performed by Heather Swift. I have been made aware that the 60 minute session is Pre-Paid and the cost is $135.00 for one person for one hour. I have also been made aware that there is a 24-hour cancellation fee with payment due in full, if I cancel my appointment and do not reschedule within a two week period. I acknowledge that I have voluntarily agreed to participate and have requested Heather Swift of Heather Healing to perform this reading and/or energy session. I acknowledge that Heather Swift of Heather Healing is not a Psychologist, Psychotherapist, Psychiatrist, Licensed Mental Health Counselor or Medical Doctor. I am aware that my participation in this reading and/or energy session is not a substitute for psychiatric treatment, psychotherapy, therapeutic counseling or any other form of professional therapy. I, _________________________________ am voluntarily participating in this reading and I accept complete responsibility for my own psychological, mental, emotional and spiritual wellbeing. I acknowledge that it is my responsibility to ascertain my own need for professional counseling and to seek such professional counseling, if needed. I also understand that if any information is given during my reading that may pertain to medical and/or mental health, this is not a declaration of fact being made by Heather Swift of Heather Healing, but only a impression Heather is receiving at the given time. I further acknowledge and understand that any information provided during this reading or any other statements made during same shall be considered confidential and shall not be disclosed except as required by law. I have carefully read this Agreement and fully understand its contents, terms and significance and understand the legal consequences of signing this Agreement. I am aware that this Agreement contains a release of liability and a contract between myself and Heather Swift of Heather Healing and I sign this Agreement of my own free will.

Please print, sign and return prior to your session: Heather@HeatherHealing.com 3585 Clayton Rd. Concord, CA 94519

Dated: ______________________ Signed: ____________________________________________ Full printed name: ____________________________________ Email: _____________________________________________ Address: ____________________________________________