Client Information Questionnaire
Please complete this form to ensure I have all the necessary information to support you in your journey of self-healing through song and sound therapy. If you have already filled out this form within the last six months and nothing has changed, you do not need to complete it again.
Do you have any sensitivity to vibration or sound?(Required)
Do any of the below apply to you?
Are you taking any medications?
Do you have any metal implants, pacemaker or piercings?
Please rate your stress level:
Please rate your pain level:
Please rate your anxiety level:
I voluntarily participate in Talena Cuthbert’s sound healing session, understanding its use of sound for therapeutic purposes, and acknowledging its risks. I acknowledge that these sessions are not a substitute for medical examination or diagnosis. I understand that these sessions are for relaxation and a form of self-care. I am responsible for my own health, I will inform the facilitator of any relevant conditions and will address any discomfort during the session.
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