Holistic Healing Circle New Client Form Name First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country How did you hear about the Holistic Healing Circle? * What would you like to receive from being in the community? * Are you under a physician or mental healthcare provider's care for anxiety, depression, or any other diagnosis? If yes, please explain: * The Holistic Healing Circle is an auto-enrollment-based service. The membership fee is $30 per month and gives you access to the group calls, the in-person quarterly gatherings, and the private social media page. The $30 fee will be automatically charged to your credit card on file every 30 days from the date of your initial enrollment. You may cancel your subscription at any time by notifying Laura Rain you would like to cancel. Upon notification, Laura Rain will cancel your membership for the next billing cycle. I understand that Laura Rain is an ordained minister whose background is in the healing arts and mindfulness coaching and teaching professions. I understand Laura Rain is not licensed and is not offering mental health services. I agree to hold Laura Rain harmless and not liable for any and all claims that may arise. I agee to the payment and cancellation policy. Signature * The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforce-ability and admissibility. Date MM DD YYYY Thank you!
