Sound Healing Form We appreciate you taking the time to review this information, complete the enclosed form and supply us with the items requested below. Please fill out this Sound Healing form prior to your appointment and send it back at least 5 days in advance to (email). If the form is received the day of our meeting, we may need to spend time reviewing it, which takes time away from your healing session. Your healing sessions will consist of a quick introduction before we start and a wrap-up afterwards. CANCELLATION POLICY If you need to reschedule or cancel your appointment, please notify us at least 48 hours in advance to avoid a cancellation fee. Any sessions cancelled within 48 hours, will incur the full session fee. First and Last Name(required) By checking this box, I agree to the Cancellation Policy for this session and future sessions. I understand this is required for any and all sessions booked. INFORMED CONSENT FORM I, Lydia Popp, am a certified sound healer, not a licensed Medical Doctor or therapist. I do not deal with pharmaceutical drugs, nor do I issue a medical diagnosis. My purpose is simply to provide a safe space for my client to experience healing through natural processes. I consider the use of sound, energy, herbs, essential oils, crystals, and any other natural healing modality as a way to encourage the body to get back to optimal functioning and everyone reacts to these methods individually. Information offered is done so on the basis of personal experience, traditional uses, scientific evidence, and biofeedback with the intent to empower and guide. My clients agree to make their own choices as to what they do with the educational material they have been offered and are solely responsible for their own decisions and actions. It is always my recommendation to seek out the advice of a licensed health care professional whenever they feel it is necessary with regards to their own personal health, especially with serious conditions. Clients need to consult with their physician and get approval to attend healing sessions if they have metal in their bodies, have a pacemaker, use an insulin pump, and the like. If in doubt, consult your physician before our time together. I understand that: An assessment will be conducted to determine the general health of my energy system. Any suggestion made by Lydia Popp will be to assist my body’s natural ability to achieve a balanced state, to the extent that my body or my highest knowing will allow. The goal of my session will be identified as part of the initial process and that I will have input as well as give intent and permission for it. These sessions are not meant to replace treatment by established medical practices and can complement them. There are no guarantees as to the results of treatment as this is a “do with” modality. Lydia Popp is not a licensed physician and will neither diagnose nor prescribe any condition nor does she make any specific claims regarding results from the sessions that I receive. Nothing in the work Lydia Popp does is considered the practice of medicine. Everything lies under the scope of holistic health and wellness. I agree to: Raise any questions or concerns about anything I do not understand. Consider any suggestions that the practitioner may raise concerning referrals to other health care practitioners, homework, or my desired focus/introspection. Take full responsibility for my own health care. Give consent to Lydia Popp to conduct a session to balance my energy system. I acknowledge that this could involves touch, and I can request otherwise. WHAT TO EXPECT In general, a typical session begins with a short assessment to discuss your concerns, thoughts, or questions. During the session you can choose to sit or lay down. While we try to make you as comfortable as possible, if you have specific needs, please bring your own pillow or blanket, etc. We make every effort to assure that our clients feel safe and comfortable. We may work on your body or above your body, so please let us know if there are any areas that you do not want work done. If you do not wish to be touched, please let us know. Our work is intuitive, so we feel the energy and work where the energy is stagnant, deficient, stuck or unbalanced. You may feel many different results such as heat or cold, shivers, nausea, headache, relaxation, release, relief, ect. You may also feel nothing at all. Any reactions can happen immediately or even months later. No reaction is positive or negative, it purely is a shift in vibration. It may mean something to you right away or it could be a mystery for a while. Both are normal. We find that energy medicine has a cumulative effect, so when you treat yourself to regular sessions, better health and well-being are natural outcomes. At the end, we will check in about anything that came up for you during the session. I have read the above statements and I understand and agree with them. My purpose to seeking the advice of Lydia Popp is done so for educational purposes. I understand that Lydia Popp does not diagnose illness, disease, or mental disorder. Nor does she prescribe medical treatment or pharmaceuticals. It has been made clear that my session is not a substitute for medical examination or diagnosis and that it is recommended that I see a medical doctor for any physical or mental ailment. I agree that Lydia Popp cannot be held liable for any problems that might arise that I think could be attributed to the energy healing season. I have stated all of my known medical conditions to Lydia Popp. If necessary, I will keep her updated on my physical, mental, and emotional health. I acknowledge that Lydia Popp practices for the purpose of providing mental, emotional, physical, and spiritual support with multiple techniques. I attest that I understand the nature of the session and freely elect to receive the techniques. I release Lydia Popp from any and all claims of malpractice, non-disclosure, or lack of informed consent. First and Last Name(required) By checking this box, I agree to the Disclaimer & Informed Consent. Phone Email(required) Mailing Address How did you hear about us? Referred by? What is your current health goal/what do you hope to get out of this session?(required) AREAS TO ADDRESS:In this section, list your main concerns. Please note that we will address as many issues as possible, but it’s often best to deal with fewer at a time. This is why booking multiple sessions is important. What do you believe is/are the cause(s) of these issues? What have you done thus far to help alleviate these issues? Are you currently under the care of a physician? If so, what for? What are your most pressing current physical and emotional health issues (acute and chronic)? Any past accidents? Operations? Do you have any specific spiritual practice? Anything else you think I should know? Do you have allergies? If so, to what? What emotions and sensations do you feel most often that you would like to shift? Submit Δ Share this:TwitterFacebookLike this:Like Loading...