Brent Atwater
Animal Medical Intuitive Diagnosis AMIDI
Animal & Pet Reincarnation
Atlanta Office: 404 898 1708 USA
Fax: 1-866-212-3298 USA
Email: Brent@BrentAtwater.com or AskBrent@live.com
Client Agreement & Release Please fill out these 2 pages completely &
return. 1 of 2 pages
I, the owner or legal guardian of (Please print)___________________________________(the
"Client"),
understand that B Brent Atwater, of Energy Work, Inc., is a
Medical Intuitive, Distance Energy Healer,
and intuitive consultant and does
not present herself as a medical doctor nor as possessing any
specific or
formal medical training, nor as a licensed, registered or certified practitioner
or counselor.
I seek and it is my intent to hire Ms.
Atwater for Consultation(s) and or Healing Energy Work(s).
No one
representing Energy Work, Inc., or Ms. Atwater offers me any false hope, false
expectations,
promises, warranties, or assurances of the success or the
outcome of any of Ms. Atwater's work.
I have read and
understand Ms Atwater's fees and that they are pre paid before my appointment
is
scheduled, and non refundable. I agree to the payment
conditions and to pay the total fee amounts for
Ms. Atwater's services in US
Funds. I choose the
following service (s). Please write clearly
1.
______________________________________________________________
Fee:_______________
2.
_______________________________________________________________Fee:_______________
If
applicable Ms Atwater's travel fees are: _________________
Initial Total service fees are:________________
If I pay by debit or credit card , I understand that by providing the
following information to Ms. Atwater,
and Energy Work, Inc., that I
agree to and I legally authorize that the debit or credit card below be charged
to pay for Ms. Atwater's Consultation(s), answers to Email questions and or
Healing Energy Work(s).
If I pay via PayPal, I agree to and
authorized that transaction to pay for Ms. Atwater's services. The
PayPal
email address is Brent@BrentAtwater.com.
I understand and agree to the following:
a. If I need to reschedule my appointment, that I am required to
give Ms Atwater's office a 24 hour notice. b. If I miss my appointment,
without giving Ms. Atwater's office
a 24 hour notice for any rescheduling, I
will be charged the full fee for Consultations and or Healing Energy
work
and or Travel arrangements. c. I call Ms.
Atwater for my sessions and pay the telephone charges.
I am eighteen (18) years of age or older, of sound mind, and not
under any mind altering drugs. By signing
this agreement, I acknowledge that
I have read the above, have thoroughly reviewed and understand its
contents,
and that I am giving my informed consent and it is my intent to agree to this
contract. By my written
acceptance of this agreement, I know this document
becomes a legally binding contract and is confidential.
Owner's or Legal
Guardian's
Signature:_________________________________________________Seal
Date: _______________________
Witness:
_______________________________________________
As the Owner and or Legal
Guardian, I acknowledge that I have read the above, have thoroughly reviewed
and understand its contents, and that I am giving my informed consent and it
is my intent to agree to this
contract. I authorize you to work with:
____________________________________________( the Client).
Signature:_________________________________________________Seal
Date: _______________________
Witness:
_______________________________________________
Brent Atwater
Animal Medical Intuitive Diagnosis AMIDI
Animal & Pet Reincarnation
Atlanta Office: 404-
898-1708 USA
Fax: 1-866-212-3298 USA
Email: Brent@BrentAtwater.com or
AskBrent@live.com
Client Agreement & Release page:
2 of 2
The method of payment for my
appointment is: Please check one of the following
Personal
Check:__________ Money Order:_________ Pay
Pal:_____________
Credit or Debit Card:________ Type of
card:_______________________________________
Name as it appears on the
card:__________________________________________________
Card number
:___________________________________________________
Please Print CLEARLY-
Expiration date of card
:_______________________
The last three numbers on signature
strip:_____________
The Billing Name and Address as it appears on the card's
statements:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
You will receive a separate form with instructions for your appointment(s)
when it is scheduled.
Thank you, we appreciate your interest in our
work!