SoundBath for Overall Health and Wellness

SOUND HEALING

Consent & Feedback Form
Consent & Feedback Form

Sound Therapy and

Crystal Healing Session

Please take a few minutes to fill out this feedback form after your sound therapy and crystal healing session. Your honest and anonymous feedback will help us to improve our service and understand the impact of our work. Thank you for your participation.
Sound Healing for Overall Health and Wellness
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date

MonthDayYear
Date
Appointment
I consent to this session
Signature

Clear
Do you have an implant for cardiac, respiratory or other medical issue.
What type of device?
How did you feel before the session? Please rate your level of stress, pain, or discomfort on a scale of 1 to 10, where 1 is the lowest and 10 is the highest.

StressPainAnxietyOther
How did you feel after the session? Please rate your level of relaxation, relief, or satisfaction on a scale of 1 to 10, where 1 is the lowest and 10 is the highest.

RelaxationReliefSatisfactionOther
How would you describe the quality of the working relationship with your practitioner? Please rate the following aspects on a scale of 1 to 5, where 1 is poor and 5 is excellent.

RapportCommunicationRespectTrust
How would you describe the results or impact of the session on your physical, emotional, mental, and spiritual health? Please rate the following aspects on a scale of 1 to 5, where 1 is none and 5 is significant.

Physical HealingEmotional BalanceMental ClaritySpiritual Connection
How satisfied are you with the overall service provided by the practitioner and the facility? Please rate the following aspects on a scale of 1 to 5, where 1 is very dissatisfied and 5 is very satisfied.

ProfessionalismSafetyComfortValue
What did you like most about the session?
What did you like least about the session?
Do you have any suggestions for improvement or any other comments?
Should be Empty:

SOUND HEALING

Sound Healing for Overall Health and Wellness