the Restoration Experience Application

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

CURRENT PATTERNS - What has been persistent for you?

add other here

What feels most urgent to address right now?*

Are you currently under medical care?*

YesNo

CONTRAINDICATION CHECK*

add other here

Single Healing Sessions 1 hour - A focused private reset designed to soften stress, clear mental noise, and relieve physical tension.

$147.00

The Private Reset - 2-hour focused restoration session. Includes curated modalities and grounding integration.

$247.00

WAIVER & INFORMED CONSENT

By submitting this application, I acknowledge:

• The Restoration Expereince provides structured wellness sessions designed to support nervous system regulation, circulation, muscular decompression, and overall well-being.

• These services do not diagnose, treat, cure, or prevent disease and are not a substitute for licensed medical care.

• I am responsible for consulting my healthcare provider regarding participation if I have medical conditions or concerns.

• I will disclose relevant health information honestly and fully.

• I understand infrared therapy, vibration, decompression devices, and light therapy may stimulate physiological responses including increased circulation, warmth, temporary soreness, detox-like reactions, or emotional release.

• I may stop any portion of the session at any time.

• I assume full responsibility for my participation and release Judy K. Martene and The Restoration Expereince from liability.

• Results vary and no guarantees are made.

I have read and agree to the Waiver & Informed Consent above*

I agree

Date*

Date

Signature*

the Restoration Experience Application

Choose Your Experience