Participants Questionaire & waiver form

Before proceeding in this energetic therapeutic session you must fully complete in this form and submit it before arrival. Without this form you will not be able to participate in the session.

This questionnaire is intended to give us a better understanding of your overall health conditions so we can better determine dosing and energetic awareness to where it is most needed. We care about you and want the best possible outcome.

It is important that you be completely honest and forthcoming while completing out this form.

I declare that: (Check all boxes)


  • 3 days prior to event consume as fresh and natural foods as possible.
  • 3 days prior to event it s best to avoid highly processed foods, alcohol and highly refined sugars.
  • Be well rested and have enough sleep before the session.
  • Sit back, relax and enjoy the ride

  • we are not responsible nor liable for the personal decisions made after the session.
  • we reserve the right to decide not to proceed with the individual session on the day itself if we feel it is not for your highest and best interest and healing outcome. If this is the case, we will reimburse your down or full payment.
By printing your name below along with todays date you confirm you have read and understood the above information and you have completed the information truthfully.