Book a Session

Fill out the form below to request an appointment.

Full Name *

Age *

Email Address *

Phone Number *

Health Considerations

Session Goals *

What would you like to focus on or achieve in this session?

Type of Session *

For Emotion Code Only Clients

Client Agreement & Consent

Consent and Release of Liability
I, the client, understand energy healing is not a substitute for medical diagnosis, treatment, or care. I release Chani Bialo from liability for any harm, injury, or damages resulting from this session. I agree to be worked on by Chani Bialo using her professional methods. I understand results aren't guaranteed and assume responsibility for my decisions and actions.

Confidentiality
The practitioner maintains confidentiality of client information.

Payment and Cancellation
Session Fee: $150 (Duration: 40 min)
- Payment Method: Zelle or CashApp (646-637-2499)
- Payment due at time of service.
- Cancellation policy: 24-hour notice required for refund.

Electronic Signature *

Typing my name below serves as my electronic signature, indicating I agree to the terms above.

Next Step

After submitting this form, you will be taken to the calendar page to pick your appointment time. Payment is processed via Zelle to 646-637-2499.