Ruqyah Healing by Al-Shifa in the United States

Terms & Conditions (Please Review)

Al-Shifa Ruqyah Services — Terms and Conditions 1. General Requirements • All service requests are subject to review and approval by Al-Shifa Ruqyah Services. • Each appointment is strictly limited to one individual per session. • Minors (under 18 years of age) must be accompanied by a parent or legal guardian during all sessions. • Female clients are required to attend in proper hijab. • Client should understand that any and every type of healing is purely from Allah (subahanu wa ta'ala) alone, and that the ruqyah practitioners are merely a means and hold no power or special abilities. • Al-Shifa Ruqyah Services reserves the right to decline or discontinue service if these conditions are not met or if conduct during the session is deemed inappropriate or unsafe. 2. Prerequisites • Complete and submit the official Client Intake Form accurately and in full. • Review and agree to all service Terms, Conditions, Consent, and Waivers prior to booking. • Acknowledge that Al-Shifa Ruqyah Services provides faith-based spiritual support only and is not a substitute for medical, psychological, or professional counseling. 3. Appointment Policy • Clients must submit an appointment request and wait for written confirmation before the session is considered booked. • Appointment requests may be rescheduled or declined at the discretion of Al-Shifa Ruqyah Services. 4. Cancellation and Rescheduling • Cancellations made 72 hours or more before the scheduled appointment may be done without penalty. • Cancellations between 72 and 24 hours prior to the appointment incur a $25 administrative fee. • Changes requested within 24 hours of the appointment are not permitted. • No-shows will be charged 100% of the service fee. • Late arrivals may result in a shortened session to accommodate subsequent appointments. 5. Conduct and Confidentiality • All sessions are conducted in accordance with Islamic etiquette and professionalism. • Clients are expected to maintain respect, modesty, and appropriate behavior throughout the session. • Personal and spiritual information shared during sessions will remain strictly confidential unless disclosure is required by law or for the client’s safety. 6. Liability Disclaimer • Al-Shifa Ruqyah Services offers faith-based spiritual guidance derived from the Qur’an and Sunnah. • The services provided do not replace medical, psychological, or therapeutic treatment. • Clients are advised to seek licensed healthcare professionals for medical or mental-health conditions. • By requesting and attending a session, the client acknowledges and accepts full responsibility for their participation and releases Al-Shifa Ruqyah Services and its practitioners from any liability arising from the session. • No specific results, outcomes, or forms of healing are guaranteed. By engaging in our services, clients acknowledge that Al-Shifa Ruqyah and its practitioners make no claims of medical or supernatural cure and shall not be held liable for any perceived, implied, or asserted promises of healing or recovery. 7. Agreement • The client agrees that all payments for consultations and sessions are non-refundable unless otherwise stated at the discretion of Al-Shifa Ruqyah Services. • By booking or attending a session with Al-Shifa Ruqyah Services, the client confirms that they have read, understood, and agreed to these Terms and Conditions.

I have read and acknowledge the Terms & Conditions above.

Confidential Client Information

Full Name Age

Gender Contact Number / Email

City / Country Preferred Method for Session

In-Person Phone Consultation

Section 1: Spiritual Background

Current level of connection with Allah

Strong Moderate Weak Unsure

Do you regularly perform the following?

Five daily prayers Morning & evening adhkar Qur’an recitation Dhikr & dua

Have you ever performed self-ruqyah?

Yes No

If yes, briefly describe Verses or supplications you already use for healing Expectations or goals from this ruqyah session

Section 2: Nature of the Problem

Please describe what led you to seek ruqyah How long have you been experiencing these issues?

Less than 1 month 1–6 months 6–12 months Over a year

Have you noticed any of the following? (Check all that apply)

Sudden fear/sadness/anger Nightmares or sleep paralysis Physical pain with no medical explanation Feeling pressure/movement in the body Hearing whispers or voices Unusual forgetfulness or brain fog Marital/family/work conflicts intensifying suddenly Loss of appetite or energy

Other (please specify) Do you believe your condition may be related to: Have you previously sought ruqyah from another practitioner?

Yes No

If yes, what was the result?

Section 3: Medical & Psychological History

Have you consulted a doctor, therapist, or counselor for this condition?

Yes No

Diagnosed medical or mental-health conditions Are you currently taking any prescribed medication?

Yes No

If yes, please specify Have you ever been hospitalized for psychological or physical health reasons?

Yes No

Do symptoms worsen when you hear Qur’an or remember Allah?

Yes No Not sure

Section 4: Lifestyle & Environment

How is your sleep pattern?

Normal Difficulty falling asleep Frequent waking Nightmares

Do you have any amulets, talismans, or charms in your possession?

Yes No Not sure

Are there tensions or major stressors in your home or work environment?

Yes No

If yes, please describe briefly Do you live alone or with others?

Alone With family With roommates

How often do you recite or listen to Qur’an at home?

Daily Weekly Occasionally Rarely

Section 5: Faith & Support System

Do you have access to regular religious guidance (imam, teacher, mentor)?

Yes No

Do you feel supported by family or friends in seeking ruqyah?

Yes No Somewhat

Would you like guidance on strengthening your daily adhkar, salah, or Qur’an routine?

Yes No

Section 6: Consent & Agreement

Al-Shifa Ruqyah Services provides faith-based spiritual guidance derived from the Qur’an and Sunnah. It is not a substitute for medical, psychological, or therapeutic treatment. For medical or mental-health conditions, please consult a licensed healthcare professional.

Digital Signature (type full name)

Date Initials

I affirm that I have truthfully completed this assessment and consent to proceed under the Terms & Conditions.