Client Intake Form Name * First Name Last Name Birthdate * MM DD YYYY Pet Name(s) (If Applicable) Email * Have you ever experienced an energy healing session (including modalities like acupuncture)? Yes No Have you experienced light language or sound healing before? * Yes No What is your intention for this session? * List any pains, illnesses, and/or symptoms you would like addressed in session you are currently experiencing (physically, mentally, emotionally, spiritually and/or energetically) * I use a range of vibrational healing tools called Resonate Essences to support in your healing. Do you have any allergies or aversions to any scents or essential oils? * I give permission for hands-over energy healing during the session. Gentle touches on the body to flow healing energy) * Yes No N/A Distance Session Additional Comments/Concerns Cancellation Policy * I understand that it is my responsibility to cancel 24 hours before my scheduled appointment to receive a full refund. Any cancellations after 24 hours will forfeit your payment in full. Yes No Please Add Your Name to Submit * I understand that Energy Healing, Reiki, or Light Language Healing Sound Healing are not full substitutes for medical examination, diagnosis, or treatment. If I experience pain or discomfort during this session, I will immediately inform the practitioner so that measures can be taken for my level of comfort. I affirm that I have stated honestly all my know medical conditions that I feel my practitioner needs to know to support me. I agree to keep my practitioner updated as to any changes in my medical profile and understand there shall be no liability on the practitioner’s part should I fail to do so. I also understand that after a healing session there is an integration period in which energy continues to release out of my system and have the responsibility to allow the changes from any and each session to settle in at a pace that is respectable for my body. Thank you! Client Intake Form
