Aura Analysis Intake Form

Aura Analysis Intake Form
Client Information
Name*

First NameLast Name
Date of Birth*

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Date
Address

Street Address

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Phone Number*
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Email*
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Emergency Contact Name*

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Phone Number*
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Health Information
Please answer the following questions to the best of your knowledge:
YesNo
If yes, please provide details:
YesNo
If yes, please list
YesNo
What would you like to experience or achieve through our work together?
What would you like support with at this time?
Aura Analysis Treatment Consent:

I understand that Aura Analysis is a holistic healing technique and is not a substitute for medical or psychiatric diagnosis and treatment. I consent to receive treatment from the practitioner named below.
Practitioner Name*

First NameLast Name
Description of Aura Analysis Treatment:Aura Analysis involves the gentle laying on of hands or non-touch energy transfer to facilitate relaxation, stress reduction, and overall well-being. The practitioner may place their hands lightly on or above various parts of the body to channel energy. The treatment may involve physical touch but will be conducted in a professional and respectful manner.

Benefits of Aura Analysis: Aura Analysis is believed to promote relaxation, reduce stress, alleviate pain, and enhance overall physical and emotional well-being. However, individual experiences may vary, and there are no guaranteed outcomes.

Risks and Limitations: While Aura Analysis is generally considered safe and non-invasive, it may not be suitable for everyone. Potential risks or limitations may include temporary discomfort, emotional release, or exacerbation of existing symptoms. It is important to communicate any discomfort or concerns during the treatment session.

Confidentiality: All information disclosed during the session will be kept confidential and will not be shared without your consent, except as required by law.
Client Signature*

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Date Signed*

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Aura Analysis Intake Form

Client Information

Health Information