PARTICIPANTS QUESTIONNAIRE AND WAIVER FORM

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.

Name

Phone

Country of origin

Date of birth

Please mention if you have any of the following conditions: respiratory, heart, hypertension (high blood pressure), psychiatric:

Please mention any medications you are taking or treatment you are undergoing:

I declare that: (Check all boxes)

I haven’t taken any drugs 72 hours prior to the session and I have not consumed any medications.

I have decided by my own will to participate in this session

I have no psychiatric or psychosis disease diagnosed by professionals

I take full responsibility for future decision making in my private life after this therapeutic session

I will not use any camera or phone to film this event

Recommendation

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

NOTE

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.

I CONFIRM THAT I AM IN A OVERALL BALANCED STATE OF HEALTH. PHYSICALLY, MENTALLY AND EMOTIONALLY

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.

I Agree

Full name

Todays Date