Booking a Healing Skype Session with Annemiek Douw A session takes 1.5 hours (2 hours max) and costs $500,-/€375,- per session. All calls are conducted over Skype. First you will be asked to fill in the consent form. When you have completed the form, it will be sent to me. You will receive a copy. Next, you will be asked to choose a date and time you would like to meet. For your convenience, all times are adapted to your local time zone. (If none of the dates available are convenient for you, you can abort the booking process at any time before the final payment is made.) Then you will be asked to pay for the session. After I have received both the consent form and the payment, I will check your aura to find out if I detect any blockages which I can work on during the Skype session. By scheduling the appointment, you give me permission to do so. Usually, I confirm or –in rare cases decline- an appointment request within 2 weeks. Note: Skype sessions are only open to clients who cannot visit my practice in the Netherlands (Europe). If you live in Holland, please visit me in my practice. To schedule a session in my practice in Valkenswaard, please do not use this form but call me on working days at +31 40 8434566 (between 8.30 am and 5 pm). Note: Evening sessions (European time) are only available to clients from outside Europe. European clients are welcome to book a daytime appointment. I really look forward to meeting you! Warm whishes, Annemiek Douw This website is secure and your data will be sent safely. Consent Form and Service AgreementName* First Last Address* Street Address City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Skype name:*Client's Stated Goal:*SouLightwork by Annemiek Douw is a service that provides support to restore the Self-healing mechanism of the body, both to individuals and within groups. I am aware that SouLightwork is in no way to be construed as or substituted for medical treatment, psychological counseling or any other type of therapy. Whilst Annemiek Douw will at all times exercise her best professional efforts, skills and care of ensuring I am supported to meet the goal for the sessions as stated above, I understand and acknowledge that Annemiek Douw and SouLight Shining BV will not be liable, legally or otherwise, for the actions I may or may not undertake as a result of the SouLightwork sessions. I hereby agree and request to have a session and/or a healing for the above stated goal, and I acknowledge that SouLightwork represents a potentially powerful spiritual, psychological, physical and emotional regulating tool. I further understand that personal results will vary and there are no expressed or implied guarantees or warranties of results. I have been fully informed of the nature and usefulness of SouLightwork. Furthermore, I am aware that this session is non-medical in nature and that no attempt has been made to diagnose, prescribe for, and/or treat any infirmity or disease, which includes spiritual, psychological, physical or emotional conditions. I have been advised to contact my health care practitioner and/or agency for any changes in medications or health care and to inform said health care practitioner and/or agency that I have chosen to utilize SouLightwork for my above stated goal. I am fully aware that the purpose of this session is to help the Self-healing mechanism of my body and heal myself and accomplish my goal, which I have stated above. I accept full and complete responsibility for any and every spiritual, psychological, physical or emotional change, or result that may occur now, or at any future time resulting from any SouLightwork sessions or consultations with Annemiek Douw. This agreement between SouLight Shining BV and myself takes effect after I have completed and signed this consent form and returned it to SouLight Shining, it has been received by SouLight Shining and payment has been effected, and SouLight Shining has provided me with confirmation of the appointment made. If SouLight Shining is of the opinion that the appointment is not in my best interest, SouLight Shining will cancel the appointment in writing. In that case, SouLight Shining will not be obliged to provide an explanation and will return any amount paid by me within fourteen days at the latest after cancellation, without an obligation to pay compensation arising in such a case. If SouLight Shining has confirmed the appointment to me in writing, I can still cancel the agreement by e-mail. If cancellation takes place up to two weeks before the date of the scheduled appointment, I will owe 20% of the paid sum in cancellation costs. If cancellation takes place in the period between one and two weeks before the date of the scheduled appointment, I will owe 40% of the paid sum. In case of cancellation within one week prior to the date of the scheduled appointment, I will owe the complete sum. In case of cancellation up to one week before the date of the scheduled appointment, the cancellation costs due will be set off against the paid sum. SouLight Shining will pay the remaining sum into my account within fourteen days after cancellation. Any costs involved in such bank transfer will be at my expense. In the event that force majeure is invoked, SouLight Shining is authorized, in consultation, to reschedule an appointment that has already been confirmed to another date and time, without this giving me the right to cancel and/or terminate the agreement as a result or creating an obligation to pay compensation on the part of SouLight Shining. The session/healing will take place between SouLight Shining/Annemiek Douw and me, the client. I am not permitted to have a third party/third parties be present during a session/healing. If I do not consent to this provision, this will result in the termination of the agreement, which means that the sum that I have paid SouLight Shining will fall due to SouLight Shining as compensation, without this giving rise to payment of compensation and/or the scheduling of a new session/healing. If I nevertheless desire the presence of additional persons at a session/healing, this must be requested from SouLight Shining in advance and in writing, and the presence of such persons will only be permitted if SouLight Shining explicitly accepts this in writing. The rate for a group session, if applicable, will be communicated and invoiced prior to the session taking place. By signing this consent form, I give SouLight Shining/Annemiek Douw the right to use the content of the session/healing as a case example during a workshop/lecture/in a publication or otherwise, in which respect SouLight Shining/Annemiek Douw is under the obligation to ensure that all details are fully anonymized, guaranteeing the confidentiality of my personal details. By signing this consent form, I furthermore waive the right to request any remuneration if SouLight Shining/Annemiek Douw exercises the right referred to in the previous sentence and/or I waive the right to have their use of content from my session/healing prohibited by operation of law. If, as a courtesy, Annemiek Douw provides links to other people or web sites which may be of value, interest and convenience to me, this does not constitute endorsement of material at those sites or any associated organization, product or service. It is my responsibility to make my own informed decision about the accuracy of the information at those sites including their privacy policies. By accessing information at and through this site each user waives and releases Annemiek Douw and SouLight Shining to the full extent permitted by law from any and all claims relating to the usage of the material made available through this web site. In no event shall Annemiek Douw and SouLight Shining be liable for any incident or consequential damages resulting from use of the material. (only for workshops:) I understand that if I use SouLightwork or any of the other techniques I am learning here in the workshop, it is possible that spiritual, emotional or physical sensations and/or unresolved issues and memories may surface. These could be perceived as negative side effects and may continue to surface after using the techniques and after the attendance of the workshop – indicating that other issues may need to be addressed. If SouLight Shining has confirmed the workshop to me in writing, I can still cancel the agreement by e-mail. If cancellation takes place up to two months before the date of the workshop, I will owe 50% of the paid sum in cancellation costs. If cancellation takes place in the period between two months and one month before the start of the workshop, I will owe 75% of the paid sum. In case of cancellation within one month prior to the start date, I will owe the complete sum. In case of cancellation, SouLight Shining will pay the remaining sum, if applicable, into my account within fourteen days after cancellation. Any costs involved in such bank transfer will be at my expense. I understand that I am fully responsible for myself and my actions at all times and that even though I can ask Annemiek Douw for predictions about the likelihood of future events, future is fluid and may change, as a result of the exercising of free will by the people involved. Therefore I take full responsibility for the decisions I make after the sessions as well as the consequences that may or not may occur. I enter into the SouLightwork sessions with full understanding that I am responsible for creating my own results. All disputes will be settled amicably or, if that is not possible, through the intervention of a competent court in the Netherlands. Dutch law applies to this agreement and any subsequent agreement as well as disputes arising therefrom. These terms and conditions have been drawn up both in Dutch and English. The Dutch version will prevail over the English version in case of any conflict. Signature*I have read and fully understand and agree to all the terms and conditions stated herein. Skype Session with Annemiek Douw Price: 375,00 € NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.
