Effective Date: March 1, 2025

"Documents marked with an asterisk (*) are required."

" POA please fill out required POA form and get a notarized letter if needed."

"Please use Adobe Fill & Sign to complete the paperwork and email it back to akinagardenhealing@gmail.com with the subject line 'Completed Paperwork for Akina Garden Healing.' Let me know if you have any questions!"

Adult Wellness Self Assessment PDF *
PDF – 3.7 KB 14 downloads
Wellness Consultation Questionnaire PDF *
PDF – 3.7 KB 12 downloads
PWA Policies Agreement PDF *
PDF – 124.5 KB 10 downloads
Cancellation & Refund Policy PDF *
PDF – 3.6 KB 14 downloads
POA Authorization Form PDF *
PDF – 3.1 KB 10 downloads
Client Intake Form PDF *
PDF – 4.0 KB 12 downloads
Pre-Registration Form PDF
PDF – 2.4 KB 9 downloads
Telehealth Client Agreement PDF *
PDF – 2.9 KB 12 downloads
NDA Agreement PDF *
PDF – 3.4 KB 13 downloads
Holistic Wellness Medical Information Release PDF
PDF – 54.9 KB 8 downloads
Established Clients Continuing Care PDF *
PDF – 108.6 KB 6 downloads
Confidentiality Form PDF *
PDF – 44.2 KB 10 downloads

"To receive services from Akina’s Garden Healing, you must complete a PWA membership form below. Once completed, I will submit your information to the database as a referral to PWA."

*Note: Include my license # on the paperwork, sign, and date. You can find my license number under the "Certifications" tab on this website for my PWA license # (You should write my PWA license # as PWA-0000000 there are 7 numbers after the dash). Without completing this paperwork and it's entirety I will not be able to digitally add you to the referral database for PWA nor see you as a client for future appointments.

PWA Member Agreement PDF *
PDF – 104.5 KB 13 downloads