Your contact information:
Full name of person to be receive healing:
Address:
City, State, Zip:
Email address:
Telephone number:
New Client?
Return Photo?
Date & time you would like healing? (please give Pacific Time USA)
Your Problem:
Brief Comment of Problem:
Yes Refer a friend:
Contact information:

Distance/Hands-On Energy Healing Order Form

Attn: Emily Huynh

Name of person to be receive healing:

Address:

City, State, & Zip:

Phone:

Brief Comment of Problem:

Return Photo?      YES              NO         (Please circle one)

New Client?        YES                  NO         (Please circle one)

Date, Time you would like healing?                            (Please give Eastern Standard Time from 10 a.m - 6 p.m)

I, (name:) _________________________________________________,REQUEST THAT: Emily Huynh practice her energy healing therapy (Check one:)                               ____upon myself or                               ____upon (recipient:)________________________________.   (Check one:) ______I have/______I have not read the web page's contents. (Check one:) ______I have/______I have not discussed with Emily Huynh about my concerns and questions that I have had about the statements in her web pages.   EMILY HUYNH'S DICLOSURE   I UNDERSTAND THAT: Emily Huynh practices a gifted, natural therapy that is performed upon the theoretical subtle-energy field surrounding and pervading the clients physical body.  Emily Huynh developed the therapy in her practice consist of energy "Chi"  and the lay on of hands on the Seven energy points called the Chakras. I understand that this spiritual healing/energy healing therapy that she practice is through her natural gift, which she developed the techniques of this therapy through years of learning-by practicing, and that she have no former education through any credential schools.  She often uses prayer and visualization through her practices.    EMILY HUYNH'S DISCLAIMER   I UNDERSTAND THAT: Emily Huynh's Energy healing therapy is not intended as diagnosis, prescription, treatment or cure for any disease, disorder, or injury, mental or physical.  Please consult your health care practitioner, medical physicians, or pyschotherapists for all advice and treatment.  It is not intended as a substitute for regular medical care.     I UNDERSTAND THAT: Regardless of any past client healing sessions with Emily Huynh, or any healing testimonials mentioned by Emily Huynh, her students and Natural Healing By Emily, as described in her web page or the school web page, is on providing support rather than "healing" or "miracle cures".  Any positive effects may or may not take place during the session. So you are aware not to expect "miracle cures" during your healing session.  As discussed in the Questions and Answers section, healing will take place or not depend on your karma, and your High Self.  Please refer back to FAQs on Energy Healing's web page.   I UNDERSTAND THAT: Emily Huynh does not practice any form of diagnosis, and that I am to continue seeing my physicians, health-care practitioners, counselors, and/or psychotherapists.  I am also to continue any medication or treatment as prescribed through my certified or licensed physicians or health care practitioner.  I understand that Emily's healing works is to provide support for: (1) faster healng recovery from illness, injury, and disorder; (2)stress-response reduction; (3)relief of suffering and anxiousness with chronic disoders, and (4)spiritual and self-realization.   I will hold harmless to Emily Huynh's Energy Healing works , and Natural Healing by Emily, and the owners from and against all liability, claim, action or expense.  I agree that I will be responsible for all my actions, reactions, results and consequences toward Emily Huynh's Energy Healing work.  I am aware that by using Emily's Energy Healing works, I may be opened to a different dimension in which I will be responsible for my wills and actions.  I agree not to leave my body spiritually during Emily's healng sessions.  I agree to abide by her rules. I allow her to perform the hands-on techniques on my body, and she is allow to lay her hands on the seven chakras energy points on my body that were discussed and illustrated on her web pages.     Signed:_______________________________________Date:________________

I would Like to Request for Emily's Spiritual Healing Sessions as follow:

(Check one:)  ____50 minutes-1 hour hands-on $120 (1/2 hour of energy transfering and the rest for resting and recuperating for both giver and receiver)                                          ____30 minutes hands-on $65 (15 minutes energy transfer to one specific area and 15 minutes rest, questions & answers )                                              ____30 minutes distance healing $45 (you can email if you have any questions or concern)                                                                        Terms & Conditions:  *All sessions have to be paid in advance.  No refund will applied, however, you can reschedule--please let us know 24 hours notice, otherwise, the fees will applied to the scheduled date as requested.  Sign up for one session first if you are not sure whether you want to continue.  The discount rates only applied to those who want to sign up for 5 or 10 sessions in advance, otherwise the regular rate for a session applies to whenever you feel like you need the session.  Thank you.     Signed:_________________________________    Date:____________________  I agreed to the terms and conditons above

From time to time we may discuss or share what Emily Huynh see, feel, and hear during her spiritual healing session with her clients.  We may use a fictitious name to discuss or share publicly about that event during the session with her.  Please let us know whether it is ok to share what Emily Huynh see during her session with you.  This sharing of information is for learning purpose only.   (Check one:) ______I agree and allow Emily Huynh to share publicly what she and I saw or discuss during my healing session with her under my real name.                        ______I agree and allow Emily Huynh to share publicly what she and I saw or discuss during my healing session with her under a fictitious name.                        _______I prefer not to share what Emily and I saw or discuss during the session I have with her to anyone publicly.     Signed: ________________________________  Date:_______________________