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SOUNDS

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About Me
Sound Healing Therapy
- Sound Healing Treatments
- Sound Journeys
Reiki Energy Therapy
- Reiki Treatments
- Distance Reiki Guidance
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Contact
- Donation Day Booking Form
- Consent Form
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Consultation and Consent Form

Please fill out this form ahead of coming in, if you have arranged for a treatment. You will only need to fill this once, unless your circumstances have changed.

Full Name

Date of Birth

Email Address

Are you suffering from a medical condition, illness, or injury?

No

Yes

Are you currently taking any medication?

No

Yes

Address:

Name and address of your GP:

Your reason for coming for healing:

Please ensure that you read the Contraindications & Data Policy before signing below.

I declare that I have read the contraindications and data policy agreement, and that the information I’ve provided is accurate & complete. I consent to receiving the requested treatment.

Signed

Thanks for submitting!

©2023 by Safiatú Lopes.

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