EmailMe Form - Sound Bath Registration Form

Date of Sound Bath *

Name *

First Last

Phone *

Email *

I understand that Sound Therapy is not for everyone and that currently we are unable to offer sound sessions to;

- Individuals in the first or third trimester of pregnancy.

- Those with a pace maker.

- Individuals with severe mental health conditions.

- To anyone with conditions that are sound sensitive. *

I can confirm that none of these apply to me and I am well and able to attend.

I understand that *

sound therapy is a complimentary therapy and is not a substitue for medical or psychological care.

I understand that *

Photographs and videos may be taken during the session and that if I do not want to be in any, I need to inform the practitioner at the start of the session.

I understand that *

I am able to lie on my back or sit comfortably for up to an hour

I understand that *

If I am aware that I don't breathe quietly and comfortably while lying on my back I ask for a chair and choose to sit from the start of the session.

I understand that *

I am aware that I may experience emotional or physical sensations.

I am happy to receive occasional email updates with future events from The Self Care Rebellion *

Yes Please

No Thank you

Signature *

Clear

Date Time *

DD / MM / YYYY