Payment Information

HealthySelf™ medicine wheel healing quilts require 50% down ($247.50) with the placement of your order.
Orders willbe processed in the order they are received, as quickly as possible.
Due to the custom design of the quilts, it may take upto ten weeks for delivery.
Balance due can be paid C.O.D. or paid upon receipt of shipment confirmation (the day of ship-ment).
No quilt will ship until paid in full. Usual shipment is via U.S. Postal Service 2-3 day delivery.
C.O.D. and expedit-ed delivery cost extra.
Standard shipping is included in the sale price of $495.00 each.

Again, anything said here is strictly confidential, what you share stays here.

HealthySelf™ OrderForm Questionnaire :

Medical History:
(i.e., chronic illnesses, any major surgery, recurrent issues—medical or emotional).

List any medications and/or vitamins/herbs:

What do you hope this HealthySelf™ quilt will do for you?:
(or the recipient)

Who will the quilt be used by (list all that apply):
Self - Family - Business/Office - Gift - Clients
(you are an energy worker, massage therapist, or similar)

This quilt will be used for:
General Healing Purposes, or a Specific Illness (if so, describe below):

If for a specific illness:
how do you feel about the illness you are facing and how do you feel about dealing with it?

Tell me just a little bit about you, your family, your life—
whatever you are compelled to share.

If there is anything else you would like to tell me:

NOW, ABOUT YOUR QUILT:

Chose your Colors: (list any and all that are appealing to you)

Blacks - Blues - Greens - Indigo (Dk. Blue) -
Oranges - Pinks - Reds - Teals - -Violets - Whites - Yellows -
Clear - strong - bright colors - soft - pastel colors - quiet neutral tones -
I like color but prefer it subdued

Use CAPITAL letters for the color(s) that energize you.
Use lower case letters for the color(s) that relax you.

Styles/Designs/Looks—I love::
abstract - amish - animal prints - asian/oriental - country -
florals - funky - fussy & feminine - geometrics - hawaiian -
kids/novelty prints - rich - classic - semi-solids - solids (like “Reiki III)

I specifically do not like:

Again, anything said or done during treatment is strictly confidential,
what goes on here stays here.

• Your information will not be shared with anyone.
• Your e-mail address will not be provided to any third party - Government or private.
• We do not create individual profiles with the information you provide.
• We do not collect information for commercial marketing.

Please read and submit below:
I understand and agree that the HealthySelf™ quilt is not a replacement
for professional medical advice.

I understand that all those associated withHealthySelf™ medicine wheel
healing quilts believe and advocate that regular medical help and advice
from medical doctor(s) and/or from professional healthcare providers
should continue to be sought and followed Information provided by
HealthySelf™ quilts and Useful Art is not to be construed as directions,
recommendations, or prescriptions of any kind. Said information is not
to be interpreted as a substitution for, or an addition to, medical advice,
opinions, or treatment from a qualified physician.

I agree to indemnify and hold Leslie Fisher and
Useful Art harmless from any and all claims and from anyand all loss,
damage, liability or expense, including cost of suit and attorney's fees,
resulting from or arising out of my use of said information
for the abovementioned purposes.

Please give 24 hours notice for cancellation.
I understand there will be a $25 "no show" fee.

By submitting your Reiki Pre-Treatment Questionnaire, you agree
to these terms and conditions. If you do not agree, you should not
submit the Content of the Questionnaire to this Site.

THANKYOU! Your HealthySelf™ medicine wheel healing quilt
will begin right away &be finished as quickly as we are able!