Date of Birth
If YES, How did the session(s) impact you?
If YES and you would like to share any further detail, please do so here
If YES, please elaborate
Do you have any internal or external scarring or sensitivity due to surgery or procedures you would like me to be aware of?
If YES, please elaborate
Are there any other medical or mental conditions or health information that I should be aware of?
What to expect from your initial session: We will start with a period of discussion so that I can understand your needs and create a customized healing experience for you. During this time, I will share with you the options for proceeding with the session based on your needs as well as how you can get the most out of it. I will also answer any questions you have. We will be working on a massage table as we proceed into the main part of the session. As this part of the session comes to a close, there will be a period of integration and grounding to prepare you for re-entry into your life with a renewed perspective.
What healing session are you open to, or seeking to receive during our time together
If you are unsure, please select 'Unsure' and I will make a time to contact you to discuss both options .in more detail.
What results would you like from your session?
I understand that the session(s) I receive is/are provided for the purpose of healing, releasing, awakening, and reclaiming wholeness. If I experience any pain or discomfort during the session, I will immediately inform the practitioner. I further understand that the sessions(s) should not be construed as a substitute for medical examination, diagnosis, or treatment. I understand that my practitioner is not qualified to diagnose, prescribe, or treat any physical or mental illness and that nothing said in the course of the session given should be construed as such. I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my profile and understand that there shall be no liability on the practitioner’s part for any reason whatsoever.
By typing my name in the box, I acknowledge that I am in full agreement with the above disclaimer and I agree that typing my name in the box below is equivalent to my legal signature.
Thank you for taking this time to share more intimately about yourself and your needs for our time together. I am very much looking forward to meeting you.
Much love, Emma Beth