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.
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?
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.
Thanks for submitting, See you very soon!