Health Waiver-Kelly Rose Wellness

Health Waiver

Please take a minute to answer the following questions before your first sound bath.

Date

First Name

Last Name

Phone Number

Add me to your email list.

Have you received a sound session before?

Do yo have any metal in your body?

Do you have a pace maker?

Are you pregnant?

Do you have tinnitus?

Are you sensitive to sound?

Do you have a vagus nerve stimulator?

Are you ok with chanting over your body?

Have you had surgery recently? where?

Sound vibrations and or energetic healing services do not substitute for the diagnosis and or treatment of illnesses, injuries, or other medical conditions by a physician and or appropriate licensed healthcare provider. However, vibrational therapy may trigger a physical or emotional reaction. Drink plenty of water. Any questions please reach out.

Your Signature

Where did you hear about us?

I want to subscribe to the mailing list.

Phone Number