Dragon Energy Healing

Name*

Date of birth*

Home Address*

Email*

example@example.com

Phone*

Occupation

How did you hear about me?

Have you experienced a professional massage or other body work, including energy healing previously?

Do you have any areas of concern or soreness?*

Do you have any of the following conditions? If so, please provide further details below.

Please provide any further details:

As a participant in the activities offered at Dragon Energy Healing, I acknowledge the holistic approach taken in the therapies provided and commit to seeking clarity if necessary. The Hawaiian Bodywork treatment encompasses the entire body, from head to fingertips, with the exception of genitalia. Should any concerns arise regarding this approach, I will address them with the therapist before the session begins.

I understand that the purpose of the bodywork I receive is primarily for relaxation and the alleviation of muscular and emotional tension. If I experience any discomfort or pain during the session, I will promptly inform the therapist to ensure adjustments can be made to the pressure or strokes for my comfort. I acknowledge that massage is not a substitute for medical diagnosis, examination, or treatment. Practitioners are not qualified to perform spinal or skeletal adjustments, diagnose conditions, prescribe treatments, or address mental health concerns. Any discussions during the session should not be construed as such.

Various forms of bodywork are contraindicated in certain medical conditions. Therefore, I affirm that I have disclosed all known medical conditions and provided honest responses to all questions. I agree to update the practitioner regarding any changes in my medical profile before each session. I understand that the practitioner reserves the right to decline to perform a service on individuals deemed unsuitable for treatment.

Release and Indemnity to the Practitioner:

By participating in these healing activities and remitting payment to Sonje Rosie, I acknowledge and agree to release and indemnify the Practitioner as follows:

- I assume all risks associated with participating in these activities.
- I release, indemnify, and hold harmless the Practitioner from any actions or claims made by me or on my behalf by other parties arising from injury, loss, damage, or death, regardless of the cause, including negligence or breach of contract.
- I waive any claim, legal or otherwise, against the Practitioner in the event of injury or damage to my property.

By signing this document, I confirm that I have read and understood its contents, acknowledging its impact on my legal rights.

Signature*

Date*

Date

General & Medical Information