Appointment Type

Name

Age

Gender

Marital Status

Country

City

Appointment Date

Email

Contact Number

Current Stressor

Booking for

Any medical or psychiatric condition

The following document is designed to give you information about MindGlown's professional services and policies. Please read this carefully. If you have any questions or concerns, please ask MindGlown at your earliest or as they arise during the course of treatment. Please note that when you sign this form it represents an agreement between us. Payment for the selected package is made prior to the session. Both Periodical and Advance adjustment will be monitored and notified by the therapist to the client. Payment will be done through direct bank transfer. Details will be shared after signing this form. Paid-Missed session will be readjusted to the next appointment. If you are late to your appointment we will still have to end on time for the curtesy of our next client, and the fee remains the same because your fee is based on the amount of time reserved not the amount used. Therapist prefer not to see you if you are very sick, and try to help you in rescheduling.