***Form needed to book first session only First Name Last Name Email List any goals that you may have for our session today and for your long term health: Please mark all that apply and provide any additional health information that you'd like us to know: Pregnancy or planning to become pregnant Cancer or terminal illness Heart condition / pacemaker Concussion or head injury in the past 6 months Recent broken bones Obesity Epilepsy Currently taking medications Other If "other", please explain: I grant my practitioner permission to use light touch and the application of weighted forks on my body. I am aware that I may verbally revoke this permission before or during my session at any point. * Yes, I grant permission No, I prefer not to be touched I have provided my information to the best of my knowledge, including pertinent health information. * Thank you! We have received your information. Please make sure to refer to our “cautions and guidelines” at the bottom of the page before booking a session. Some conditions respond very well to Biofield Tuning, others not so much.Please, refer to our cautions and guidelines before booking.