Client intake
Please fill this in before your first visit. It takes about 10 minutes. Only your practitioner reads it.
A parent or legal guardian fills in and signs the forms for a child under 18. Answer every question about your child. For more than one child, send one form each.
These questions help us decide whether a Seraphim session is safe and appropriate. They are not used to assess or address any medical condition. If any answer is yes, we may ask you to check with your healthcare provider before booking.
Which symptoms would you like to feel better? Choose each one (sorted by category, like on the Seraphim device) and rate how bad it is now; 10 is severe. At each visit you rate them again, so you can see your progress.
Seraphim sessions are a wellness experience. They are not medical care, and they are not a substitute for evaluation, diagnosis, or treatment by a licensed healthcare provider. Your practitioner does not diagnose conditions or prescribe treatment.
Please keep your physician or healthcare provider informed about the wellness services you use, including Seraphim sessions. Do not stop, change, or delay any prescribed treatment because of a session. If you are under the care of a specialist including an oncologist please talk with them before beginning.
If you feel unwell during or after a session, please tell your practitioner and contact your healthcare provider. Discomfort is not an expected part of the process.
Sessions are scheduled at whatever interval works for you and your practitioner. Consistency is important: sessions are typically scheduled weekly for best results.
Appointments are reserved exclusively for you. Please provide at least 48 hours' notice if you need to cancel or reschedule an appointment.
Appointments cancelled or rescheduled with less than 48 hours' notice will be charged the full session fee.
Standard Cellular Coherence Sessions are approximately 60 minutes in length. Requests to modify session length must be discussed with your practitioner in advance.
Payment is due at the time of service unless other arrangements have been made in advance.
A $75 fee will be charged for any returned checks.
If you arrive late, your session may be shortened to respect the schedules of other clients, and the full session fee will still apply.
If you need to contact Seraphim Wellness between sessions, please leave a voicemail, send an email, or send a text message.
Messages are typically returned within one business day; however, immediate responses cannot be guaranteed. Electronic communication is intended for scheduling, administrative matters, and brief follow-up questions only. Please do not use voicemail, email, or text messaging for urgent health concerns or emergencies.
Seraphim Wellness does not provide emergency services. If you are experiencing a medical emergency, call 911 or seek immediate medical attention. Virtual or telephone wellness consultations may be available when appropriate.
To protect client privacy and maintain professional boundaries, Seraphim Wellness does not accept friend or connection requests from current clients on personal social media accounts.
Clients are welcome to follow public business pages and social media accounts associated with Seraphim Wellness.
While reasonable efforts are made to protect your privacy, the confidentiality of electronic communications, including text messages and email, cannot be guaranteed. By choosing to communicate electronically, you acknowledge and accept these risks.
Electronic communications should not be used to share urgent, sensitive, or time-sensitive information.
Clients under the age of 18 must have a parent or legal guardian complete all required forms and provide consent before services are provided.
A parent or legal guardian may be required to remain present during sessions.
Information shared by minors will be handled in accordance with applicable laws and with consideration for the minor's privacy and well-being.
Clients may discontinue services at any time.
Seraphim Wellness reserves the right to discontinue services if:
If no appointments are scheduled for 90 consecutive days and no prior arrangements have been made, the client relationship may be considered inactive.
When appropriate, referrals to other wellness practitioners or licensed healthcare providers may be recommended.
By signing below, I acknowledge and agree that:
Please read this document carefully and ask any questions before signing.
Seraphim Wellness provides wellness services that may include Cellular Coherence Sessions, biophoton light applications, pulsed electromagnetic field (PEMF) sessions, energetic assessments, and wellness education. These services are intended to support the body's natural regulatory processes and overall well-being. The practitioner may assess points on the hands, feet, or other areas of the body commonly referenced in traditional acupuncture systems to identify patterns and support wellness recommendations. These assessments are non-diagnostic and are not intended to replace medical evaluation, diagnosis, or treatment. In some sessions, a single sterile, disposable needle may be used at a limited number of points as part of the wellness session. Needle use is optional and may be declined at any time.
Services may be provided to me by Seraphim Wellness LLC and/or by one or more independent practitioners who are affiliated with Seraphim Wellness and who operate under their own business entities. In this document, the terms "practitioner" and "provider" refer to whichever of these parties provides my services, and my consent and the releases in this document apply to Seraphim Wellness LLC and to each independent practitioner affiliated with Seraphim Wellness who provides services to me, together with their respective business entities whether or not any of them is named individually.
I understand that the services provided by Seraphim Wellness are wellness services only. These services are not intended to diagnose, treat, cure, prevent, or mitigate any disease or medical condition. No medical advice is provided during sessions. I understand that the practitioner is not acting as a physician, psychologist, or other licensed healthcare provider unless otherwise disclosed. I understand that these services are not a substitute for professional medical advice, diagnosis, or treatment. I agree to continue working with my licensed healthcare providers regarding any medical concerns and understand that I should not discontinue medications or alter treatment plans without consulting them.
I understand that certain conditions may make Cellular Coherence Sessions, biophoton applications, or PEMF services inappropriate or require modification. I agree to disclose any relevant medical history, including but not limited to:
I confirm that I have disclosed all relevant health information. I understand that participation may be modified, postponed, or declined at the practitioner's discretion. I understand that certain surgeries or procedures, including vasectomy, may affect how the body responds to sessions and that results may vary.
I understand that individual responses vary and that no specific outcomes or results are guaranteed. I understand that some individuals may experience temporary changes in physical, emotional, or energetic patterns following a session, including changes in sleep, energy, mood, digestion, elimination patterns, and symptom awareness. These responses vary among individuals and are not predictable. If I experience severe, persistent, or concerning symptoms, I agree to seek appropriate medical care promptly.
I understand that, in some sessions, a single sterile, disposable needle may be used at a limited number of points as part of my wellness session. Potential risks associated with needle use may include temporary discomfort, minor bleeding, bruising, dizziness or lightheadedness, temporary soreness, and a rare risk of infection. I understand that I may decline or withdraw consent for needle use at any time without affecting my ability to receive other wellness services.
I understand that pulsed electromagnetic field (PEMF) technology may be used during my session. I understand that PEMF is intended to support general wellness and is not intended to diagnose, treat, cure, prevent, or mitigate any disease or medical condition. I agree to notify the practitioner of any implanted electronic devices or other conditions that may make PEMF inappropriate.
I understand that participation in these services is voluntary and that I may decline or discontinue services at any time. To the fullest extent permitted by Idaho law, I voluntarily assume responsibility for my participation and release and hold harmless Seraphim Wellness LLC, Elizabeth Talboy, and each independent practitioner affiliated with Seraphim Wellness who provides services to me, together with their respective business entities and each of their owners, members, managers, employees, independent contractors, and representatives (collectively, the "Released Parties"), from any claims, demands, damages, losses, liabilities, costs, or expenses arising from or related to my participation in these wellness services, except in cases of gross negligence or willful misconduct. Each of the Released Parties is an intended beneficiary of this release. Where services are provided by an independent affiliated practitioner, I understand that practitioner is solely responsible for the services he or she provides, and that Seraphim Wellness LLC and the other Released Parties are not liable for those services.
My records will be maintained in accordance with applicable privacy laws and business policies. My information will not be released without my written authorization unless required or permitted by law. I authorize the practitioners and affiliated providers involved in my care to share my relevant records and session information with one another to the extent reasonably necessary to coordinate and deliver my services.
By signing below, I acknowledge and agree that: I have read and understand this document; I have had the opportunity to ask questions; I understand the nature and purpose of the services provided; I understand that these services are wellness services only; I understand that no diagnosis, treatment, cure, or prevention of disease is offered or implied; and I understand that individual results vary and are not guaranteed. I voluntarily consent to receive services from Seraphim Wellness LLC and any independent practitioner affiliated with Seraphim Wellness who provides my services.
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