Sound Healing with Crystal Bowls

Sound Healing Client Waiver

First name

Last name

Phone

Birthday

Day

Month

Year

Do you have Epilepsy?

Yes

Are you pregnant or trying to become pregnant?

Yes - pregnant

Yes - trying

Do you have any medical or metal implants?

Yes

Do you have any other condition we should be aware of (if so, please provide details)

I have voluntarily chosen to participate in the Sound Healing service provided by Sally Heinjus.

I have read, understood, and agree to the Terms and Conditions (https://www.sallyheinjus.com/soundtermsandconditions)

I release and discharge Sally Heinjus from any liability, claims, demands, or causes of action arising from my participation, past, present

and future relating to this treatment except where prohibited by law.

I confirm that all information provided on this form is true and complete to the best of my knowledge.

Signature

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