• Sound Healing Client Intake Questionnaire

  • Basic Information

  • Format: (000) 000-0000.

  • Session Experience

  • Is this your first Sound Healing session?*
  • Have you previously experienced any of the following?*

  • Current Wellness & Support

  • Physical Body & Discomfort

  • Are you currently experiencing any physical pain, tension, discomfort, or areas of sensitivity in the body?

  • Physical Pain/Sensitivity*

  • Emotional & Nervous System Support

  • How have you been feeling emotionally, mentally, or energetically lately?
  • Emotional/Mental/Energetic State*

  • Sound & Sensory Sensitivity

  • Do you have any sensitivity to sound, vibration, frequencies, or loud noises?*

  • Medical Considerations

  • Session Enhancements (Optional)

  • Are you interested in any optional add-ons?

  • Intentions

  • Consent & Acknowledgment

  • Sound Healing sessions are complementary wellness practices intended to support relaxation, grounding, stress reduction, and nervous system regulation. These sessions are not a substitute for medical or psychological diagnosis or treatment. I acknowledge that I have disclosed any and all relevant medical conditions, injuries, sensitivities, implants, diagnoses, medications, or health concerns that may impact my session experience, and understand that it is my responsibility to inform the practitioner of any updates or changes prior to my session. By signing below, you acknowledge that you are voluntarily participating in this session and understand the nature of the services being offered.
  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
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  • Should be Empty: