Zenful Aura

1794 Bridge St Unit 5B, Dracut, MA 01826

https://zenfulaura1212.com

zenfulaura1212@gmail.com

Client's Name:*

First NameLast Name

Birth Date*

MonthDayYear

MaleFemaleI prefer not to answer

Email*

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Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

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How did you hear about us?

YesNo

If you chose "Other", please specify:

Heart conditions or pacemakerEpilepsy or history of seizuresHearing impairments or sensitivity to sound frequenciesMental health disorders (such as severe anxiety, PTSD, schizophrenia, etc.)Recent surgeries or injuriesSensory processing disordersPregnancyOther health concernsI don't have any of the following medical conditions

If you checked off "Pregnancy", how many weeks?

If you checked off "Other health concerns", please specify:

Are you currently taking any medications that may affect your sensitivity to energy healing or sound healing? If yes, please specify.*

Are you currently under the care of a healthcare provider for any medical or psychological conditions? If yes, please specify.*

YesNo

Do you have any allergies or sensitivities to essential oils, incense, sage or crystals? If yes, please specifiy.*

Consent & Liability Waiver
Acknowledgment & Agreement

By submitting this form, I acknowledge and agree to the following:

I understand that the services provided (sound healing, Reiki, chakra healing, and crystal healing) are complementary holistic therapies and are not a substitute for medical or psychological treatment.

I understand that the practitioner does not diagnose, prescribe, or treat medical conditions and that I should consult a licensed healthcare provider for any health concerns.

I confirm that I have disclosed all relevant medical conditions, mental health concerns, and sensitivities that may affect my ability to receive these services safely.

I acknowledge that individual experiences vary and that I am responsible for my own well-being during and after the session.

I understand that temporary detox-like symptoms, emotional releases, or energetic shifts may occur after a session.

I understand that if I feel uncomfortable at any time during the session, I have the right to stop or request modifications.

I understand that any form of sexual harassment, misconduct, or inappropriate behavior will not be tolerated and will result in immediate termination of the session, with no refund provided.

I acknowledge that sound healing may not be suitable for individuals with pacemakers, epilepsy, severe mental health disorders, or extreme sound sensitivity, and I confirm that I do not have any contraindications that would make this practice unsafe for me.

I release Zenful Aura and its practitioners from any liability for outcomes related to these holistic services.

I understand that all sessions are by appointment only and that cancellations or rescheduling require at least 24-48 hours notice.

Confidentiality Agreement

I understand that all personal and medical information shared with Zenful Aura is confidential and will not be shared without my written consent, except when required by law.

Injury Liability Waiver

I understand and acknowledge the following:

The services provided by Zenful Aura, including sound healing, Reiki, chakra healing, and crystal healing, involve gentle touch, vibrations, and energy work. These are non-invasive holistic therapies intended for relaxation and well-being.

I understand that while these services are considered safe for most individuals, there is always a possibility of experiencing temporary discomfort, dizziness, emotional releases, or mild physical sensations as part of the energetic healing process.

I acknowledge that sound vibrations, Reiki energy, and crystal frequencies may interact with my body's energy field in ways that vary between individuals, and I assume full responsibility for my participation in these sessions.

I understand that any discomfort, dizziness, or imbalance I may experience is temporary and should subside within a reasonable time. If I have concerns, I will consult my healthcare provider.

I release Zenful Aura and its practitioners from any liability for injuries, discomfort, or adverse reactions that may arise before, during, or after my session. I agree that I am participating voluntarily and at my own risk.

I confirm that I have disclosed any relevant health conditions, medical sensitivities, or contraindications that may affect my ability to receive these services safely.

I give permission for my session or testimonials to be used anonymously for marketing or educational purposes.I do not consent to any use of my session details for marketing or promotional purposes.

Client Agreement & Consent

"I acknowledge that I have read and understand the information provided in this form. I affirm that the services offered, including sound healing, Reiki, crystal healing, and chakra alignment, are complementary wellness modalities and do not replace medical or psychological treatment. I take full responsibility for my health and well-being during and after the session.

I have read, understand, and agree to the terms outlined above. (Required for submission)