(Confidential, for therapist use only)

Internet intake form – recommended option

This intake form will be sent by internet once you have completed it and filled out the consents. This will give Mr. Bérard the opportunity to get to read it before your RV and will save a lot of time at the first session. Once it has been sent, you will receive a copy

  • Contact person information

  • Group information

  • Description of the Group

  • Consent to energy treatment on a group
    (Please read the following information and sign the form.)
  • My approach is holistic and focuses on your group as one unit complex, dynamic and composed of single individuals in the group. I serve as a facilitator in the healing process and harmonization of the group.

    The information you shared me is confidential. For cons, I sometimes discuss my clients anonymously supervision or with pairs in order to evolve as a professional.
    The clean energy balancing techniques, recharge and balance the energy field of the group and thus facilitates the dissolution of energy blockages that contribute to the dysfunction and disharmony in the group. This unlocks the potential of the group.
    Please contact me with any questions about my services

    Roland Bérard

    Cancellation Policies and returned checks

    Canceling an appointment

    Please advise at least 48 hours in advance if you must cancel your appointment. Otherwise, the full payment for the treatment is due and must be paid before continuing the next treatment.

    Checks returned by the bank

    The $ 15 fee applies if a check is returned by the bank.

    The group's representative person confirms that it presented the group in its own name and good liver and for no other reason than getting energy treatments.