Evolve 12 week program

EVOLVE
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Hi! Can you briefly tell me what has brought you here.......
Transformational Breathwork JourneysRoot Cause TherapyRelaxation and Breath Training BreathworkEmotional Integration TherapiesSomatic ProcessingEFTOther
AsthmaMuscular InjuryJoint InjuryPregnancyHigh blood pressureLow blood pressureDizzy/Fainting spellsSeizuresDiabetesSleeping IssuesSurgery in the last 5 yearsPanic attacksAnxietyDepressionPTSDSkin conditionsFlu-like symptomsTrauma related issuesSleep apneaSnoringCurrently smokingSmoked in the pastNone of the aboveOther
NeckShouldersUpper backLower backLegsHipsArmsHead or faceNone of the aboveOther
Have a family history of allergiesHave a family history of epilepsyHave a family history of asthmaHave had dental extractionsHave had dental appliances or bracesTonsils removedAdeniods removedRoot canal therapyMercury amalgam fillingsSuffered from TMJ priblemsHave had Jaw/TMJ surgery
EpilepsyChronic Heart ConditionsChronic AsthmaFirst trimester of PregnancyScizophreniaBipolar DisorderRecent Brain InjuryNone of the above
DISCLAIMER - Please Read Carefully

I, the undersigned, understand that Breathwork, Root Cause Therapy, Emotional Healing Processes, Somatic work, EFT and Meditation are not a substitute for medical attention, examination, diagnosis or treatment and any changes to prescription medication or medical appliances should be discussed with my prescribing practitioner.

I should consult my GP prior to beginning any program for my overall wellbeing.

I accept that neither the ‘Instructor’, nor the ‘Hosting Facility’ is liable for any injury, or damages, to person or property, resulting from participating in these sessions.

I am aware of the benefits and risks of these sessions and that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments and that there may be additional risks based on my physical condition.

I understand that I will have the opportunity to discuss with the facilitator the nature of the modality and any other procedures.

I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status.

I understand that I have the right to notify the therapist if the pressure needs to be altered and that I am also able to terminate the session at any time.

I have been given a chance to ask questions about the session and my questions have been answered.

I have read and consent to the above, and by signing below I agree to the above named procedures.

I understand that this is a course of health education which includes breathing exercises and lifestyle guidelines.

I understand that the method taught to me is tailored to suit me and that completion of this does not qualify me to teach any part of this.
PHOTOGRAPHY WAIVER Please be aware that Soultree Moves will be taking photos and/or videos that are considerate of a person in a process. Soultree Moves may use the material produced to further promote the essence of its' work through social media, newsletters and website. To ensure the privacy of individuals, images would not be identified using full names without written approval from the photographed subject. Do you consent to images being recorded?

YesNoLeaning towards yes, but please show me and ask me first
PAYMENT METHOD

To BEGIN AND secure your booking, please head to https://www.trybooking.com/CXWDW

Please use the Discount Code: EVOLVEME to receive $150 discount.

This price is inclusive of

1 x Discovery Session

3 x Rediscover Sessions

3 x Zoom Call Check Ins

6 x Soul Work Sessions - up to 3 Breathwork Journey Sessions max

Once I receive this form, I'll contact you to organise a Discovery session time and this will give me a chance to learn more about you and how I can help, and, we will work out your tailored plan according to the findings.

We can always change these up in the future depending on what is needed at the time.

Please read the Terms and Conditions below carefully.
TERMS AND CONDITIONS

Soultree Moves is a small business sole trader. We spend a lot of time and energy in preparing for your appointments and often paying fees on your space of healing beforehand.

We understand that unanticipated events happen occasionally in everyone's life. In our desire to be effective and fair to all clients, the following policies are honoured.

- Your program must be completed within 16 weeks of first session.

- Cancellation of full program at any time will forfeit 50% of remaining fees minus $20 non-refundable Booking Fee.

- Rescheduling - Please give minimum 48 hrs notice otherwise $20 extra Booking Fee will be applied.

- Missing an appointment - Without any or proper notification will result in a 100% forfeit of your session fee. (Confirmation reminders are sent the previous day)

- If you arrive late, your session may be shortened in order to accommodate following appointments. Depending on how late you are, your therapist will determine the best treatment plan for the time remaining. You will still be responsible for the 'Full' sessions payment.
Between the hours of 9-5pm weekdaysAfter work hoursWeekends onlyIt will vary each time
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Were you referred by someone in the Soultree Moves community? If yes, who? We'd like to thank them.
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