Discover Your Healer Within
Intuitive Body Reading
Energy Healing
Medical Astrology
Couples Restorative
Rosemary Serluca Foster
Intuitive Body Reading ● Energy Healing ● Medical Astrology ● Couples Restorative
  • About Rosemary
  • Services
    • Intuitive Body Reading
    • Quantum-Touch Healing
    • Energy Healing
    • Medical Astrology
    • Couples Restorative
    • Craniosacral/IBR Combo
  • Testimonials
  • Media
  • Pay
  • Book
  • Forms
    • Intake Form
    • Release Form
  • Contact

Intake Form

After you have booked your appointment with Rosemary, please fill out and email the following form prior to your session date. Asterisked lines indicate required entries. There is an automatic submit button below the form. Thank you!

  • Declaration of Release of Liability

    Except in the case of gross negligence or malpractice, I, or my representatives, agree to full release and hold harmless, Rosemary Serluca-Foster and Rosedove Healing from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

    Use your mouse or track pad to sign below.

  • Date Format: MM slash DD slash YYYY
  • Energy Medicine Professional Association Insurance

    The liability policy that the Healing Touch Professional Association (HTPA) provides to qualified members covers the member's practice operations for professional liability (coverage if client alleges malpractice), general liability (coverage if client alleges injury [accidents] due to member's negligence), and products liability (coverage if client alleges reaction to product). The insurer will also defend the member if someone sues alleging their wrongdoing in covered losses: those legal expenses are provided in addition to the policy limits.

 

 

Contact Me

rosemary@rosedovehealing.com
212-989 2033

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