Client Information Questionnaire Please fill out as much as you can so that I have the information needed to give you the treatment and healing that you need. If you have filled out this form within the last 6 weeks and nothing has changed, you do not need to fill it out again.
What date is your Sound Treatment with Talena(Required)
What is your current method of relaxation?
What are the main stressors in your life?
Do you have any sensitivity to vibration or sound?(Required)
If yes, please provide details:
Do any of the below apply to you?
Please provide more details of your condition if you feel this will help with your Sound Therapy Treatment.
Are you taking any medications?
Please list any surgeries or injuries in the last 2 years:
Do you have any metal implants, pacemaker or piercings?
Please rate your stress level:
Please rate your pain level:
Please rate your anxiety level:
Do you have any concerns that may affect your sound therapy treatment?
How did you hear about me and my services?
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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