Health Declaration (Group Sessions)

HEALTH DECLARATION

We are looking forward to welcoming you at your upcoming sonic experience.

We believe that sound therapy is for everybody and that it can help support your health & wellbeing.

That said, individuals MUST consult with a medical practitioner in advance of a session with us if they have any concerns.

First Name

You only need to complete this form

prior to your your first session with us

or if you need to inform your facilitator about any changes of details or health.

Last Name

Date of Birth

CONTRAINDICATIONS

Do you have any known sensitivities to sound?

Do you have any difficulties laying on your front or back?

Do you have any metal implants, pacemaker, epilepsy or sound-sensitive conditions?

Do you have any serious mental health conditions?

Are you pregnant, if so how many weeks?

Is there anything else that you would like us to know about?

CONDITIONS/ NOTES

Emergency Contact Name

Emergency Contact Number

Privacy: No information about any client will ever be discussed with or shared with any third party unless expressly requested by client.

I have no health concerns and all good to attend the upcoming session/

I have a condition that may be effected by this session but I have consulted my doctor and I have chosen to attend based on the medical advice given.

I understand the practitioner will be using vibration and sounds during this session. I have completed this form to the best of my ability providing any details that the facilitator should be made aware of. I acknowledge that these sessions are not a substitute for medical examination or diagnosis. I understand that these sessions are for relaxation and a form of self-care.

I have read all of the above and assume responsibility for my own health & wellbeing.

I would like to subscribe to the newsletter.

Thanks for submitting, See you very soon!

CLICK HERE TO READ FAQ

HEALTH DECLARATION

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