SRT/RSR INTAKE FORM | Kristy Engelke Healing

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RSR Intake Form & Consent

Please fill out this form for your Spirit Release Therapy (SRT) / Remote Spirit Release (RSR) clearing session. Upon receipt of payment, we will complete your session within a week or earlier. You will receive a report of findings and an aftercare information and instructions. The rates for the services are equally shared with myself and the Certified Medium. Our intention is to offer transformative healing experiences that feel deeply supportive, accessible, and rich in value.

Need your RSR clearing sooner? Please select the Emergency Complete Comprehensive Detailed RSR and we will have it completed 36 hours upon receipt of payment.

Thank you for trusting our team and our Spirit Guide team to carry out your session. We look forward to assisting you and providing this service for you!

Recipient Full Name (Person receiving the RSR clearing)

Recipient Date of Birth

Recipient Age

Current Location of Recipient/Person Receiving RSR Clearing (City, State & Country, if client will be traveling - include their travel location)

Recipient's Gender or Preferred Pronoun

Client Name (Person paying & booking clearing for Recipient)

Your Relationship to the Recipient

Email Address (to send report to)

I certify that I am at least 18 years old Required

Yes

Female Clients: I certify I am NOT pregnant / recipient is NOT pregnant Required

Yes

N/A

I agree to not publish the report and/or any of its findings on any social media platforms due to the personal nature of this work. The report and its findings remain strictly confidential between the client and practitioners Required

Yes

Briefly describe your reason for having a RSR session

3 Questions Option for COMPLETE COMPREHENSIVE DETAILED RSR ONLY (list up to 3 questions you would like to ask the guides)

***Please Note - we cannot guarantee they will answer all 3 questions as every individual is on their unique soul journey and it is up to the discretion of the guides as some information may not be for their highest good in that moment. However, we will ask your questions on your behalf.

Service Agreement and Liability Release

1. I understand that Kristy Engelke is not a licensed physician and does not diagnose, cure or prevent any disease and does not practice medicine. She is not a psychologist or counselor and does not treat mental illness or provide personal advice or counseling. All guidance and healing in the sessions is spiritual in nature with the spirit team working with the client’s Higher Self. I am fully responsible for making my own decisions.

2. I understand the above modalities are not substitutes for regular medical care and I have been advised to consult my regular medical doctor or health-care practitioner for treatment of any old, new or existing medical conditions.

3. I understand the insights provided come from their experiences and are shared for informational purposes. This practice is not a substitute for medical care. Results are not guaranteed.

4. I understand that any information, guidance or messages that are brought forward from the client’s Higher Self, their own Higher Being, and Spirit Guides are solely for personal education and entertainment purposes only.

5. I understand that this RSR session is solely for educational and entertainment purposes. RSR is not a substitute for medical or psychological advice from a medical or mental health professional. Only a medical professional or mental health professional can provide medical or psychological advice.

6. I agree to full release and hold harmless Kristy Engelke from and against any and all claims or liability of any nature arising out of or in connection with my sessions.

7. I agree not publish the report and/or any of its findings on any social media platforms due to the personal nature of this work. The report, my personal information and its findings remain strictly confidential between the client and practitioners.

8. I understand once the RSR session has been completed, it is nonrefundable.

9. I understand because life circumstances may arise and I need to cancel my session, only cancellations done within 24 hours of payment will be refunded with a $10 service fee.

I agree and accept these terms & conditions

By signing electronically, I accept the terms and conditions of the Responsibilities and Liability Release and I confirm that my information is accurate and true.

Your Signature

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