Client Form / Agreement

I have a Masters Degree in Counseling Psychology and am a licensed therapist, however, it is important to understand that the service I am providing is not a psychotherapy process. Though informed by my training in psychology, our work together is a blend of holistic/spiritual counseling, expressive arts therapy and energy healing for personal growth.

Please fill out the form below with your information, in agreement with the following:

I am entering a relationship with Shanel Jackson to receive holistic counseling, coaching and healing services for personal growth with the understanding that she is not engaging in the practice of clinical counseling or psychotherapy and will not diagnose or attempt to treat mental illness. I understand that healing services are spiritual and energetic and that Shanel Jackson is not a licensed physician and will not attempt to diagnose or treat disease or symptoms of illness.

I understand that should I become aware of or suspect a medical or psychological condition I am encouraged to seek out the appropriate health care professional.

I agree to pay the monthly fee in full before any services are provided. I understand that there is a 24 hour cancellation policy and fees will not be refunded if I do not change or cancel my appointment at least 24 hours in advance. Should I fail to reschedule appointments of a prepaid program within 2 weeks of their original date, I will not receive a refund. 

I agree with Shanel’s privacy policy and to be added to her client mailing list to receive newsletters and notices with the understanding that my information won’t be shared with anyone and I can unsubscribe at any time. Click here to read full Privacy Policy.