Please fill out this form to sign up for your free consultation. One Elite Energy will get back to you within 24-48 hours. Name * First Name Last Name Email * Phone * (###) ### #### Do you have any particular traumatic event/s you would like to mention? If so, please mention age/s and details? * Tell us what is going on and how we can help you? * This helps us understand and assess if we are a good fit for you and your circumstance. We value your time and energy and want to make our intake process as smooth as possible for you. What Have You Tried Before? This question helps Michael and Kathy understand your journey and the effort you've put into healing. *Check all that apply. Talk Therapy Medication Energy Healing Reiki Religion What Time of Day Works Best To Call You? * Before Noon After Noon Early Evening Please enter your timezone * Liability Waiver * Michael Soto and Kathy Eilers, and any other practitioners of One Elite Energy, Inc. are providing a service assisting you in mind, body, and spirit integration through the use of modalities that may include, but not limited to reiki treatment, shamanic healing, guided meditations and imagery, private consultations, and any other energy work. You, the participant, hereby agree to assume all risks associated with any outcome resulting from your participation in One Elite Energy, Inc. programs or private consultations with their practitioners. Side effects may include, but are not limited to, emotional release, lightheadedness, mild fatigue, physical tingling, and change in body temperature. All information, mental or physical activity, guidance, and direction are provided during programs and private consultations to enhance your well-being. As a participant, I am responsible for informing the practitioner if any discomfort should arise. It is my responsibility, as a participant, to notify the practitioner ahead of treatment of any pre-existing medical conditions or injuries. By signing this Waiver and Release of liability, you agree that neither Michael Soto, Kathy Eilers, or any other energy healer working for/with One Elite Energy, Inc. nor One Elite Energy, Inc. shall be responsible for any negative consequence of any kind which is claimed to result from: 1) your participation in any of these programs, activities or consultations; or 2) from the use of any information learned or obtained during these programs, activities or consultations, including, but not limited to, reiki treatment, guided meditations and imagery, energy healing, chakra healing, energy work, yoga, private consultation or any other activity provided during One Elite Energy, Inc. programs, classes, or private consultations. By signing this Waiver and Release, you further agree not to assert any legal claims of any kind in any form against Michael Soto, Kathy Eilers, or any other energy healer working for/with One Elite Energy or One Elite Energy, Inc. on any asserted negative consequence resulting from your participation in these programs, energy healings, meditations, and imagery, or private consultations. By signing this Waiver and Release, you acknowledge and agree that Michael Soto, Kathy Eilers, or any other energy healer working for/with One Elite Energy or One Elite Energy, Inc. disclaim all liability for any injuries or negative consequence claimed by you to be the result of your participation in these programs, energy healings, meditations and imagery, or private consultations. I recognize that in no way does Michael Soto, Kathy Eilers, or any other energy healer working for/with One Elite Energy, Inc. provide legal, medical, or therapeutic advice, and it is my responsibility to secure such advisement. I have read and understand the Liability Waiver and Release Signature * By typing in your name below, you agree that this is a legal representation of your signature. Thank you, Michael and Kathy will be in touch very shortly.
