Request a Session

Please share a few details so we can understand your needs before we connect. Once we review your request, we’ll personally reach out to arrange a suitable session time. All information you provide is kept private.

First name

Last name

Phone

Are you currently taking any medication?

Have you ever had psychiatric treatment?

Do you have any physical or medical condition?*

Primary Concerns

I have read and agree to the Terms of Use and Privacy Policy.

I give consent to receive healing services for myself (or my minor child) and understand that the services provided by the practitioner at Cosmiyana are intended to enhance relaxation and support overall well-being. I understand that these services are not a substitute for medical treatment or medications. Diagnosis is not given, and medication is not prescribed.

I understand that participation is voluntary, and I may choose to end it at any time. I also acknowledge that I may experience healing responses during the 24 to 48 hours following a session.

I give permission for the practitioner to use aspects of my case (such as session insights or healing outcomes) for educational purposes, without revealing my name or identity.

By providing this informed consent, I acknowledge full responsibility for my participation and hold harmless both the practitioner at Cosmiyana and the facility or online platform through which the services are provided, whether in person or virtual.

Request a Session

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