Vanessa Wood - Energy Therapy

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Client consent and disclosure form

Your preferred first and last names *

Age *

Phone number *

Email *

How did you hear about Vanessa? *

What are your goals for this session? *

Improve my energy levels

Improve my physical health

Improve my mental health

Improve my spiritual life

To feel better

I'm just curious about trying energy therapy

Other

Required

Do any of these contraindications (situations in which an energy therapy session would not be recommended) apply to you?

Terminal illness

Cancer

Heart condition/pacemaker/electronic implants

Concussion/head injury/broken bones in the last six months

Heavy metal/poison detoxing

Pregnancy/trying to get pregnant/breastfeeding

Varicose veins (not contraindicated, but could cause discomfort)

Morbid obesity (not contraindicated, but could cause a severe detox)

Clear selection

Please give more information about your past and present physical, mental, emotional and spiritual health. Bullet points are fine. (Not required if you have already had a Reading & Consultation appointment.)

Disclaimer

Please read the following carefully:

1) Energy therapy is designed to assess where they body's electromagnetic and subtle energies are blocked or are in dissonance, then correct the flow of these energies in order to boost health and vitality.

2) Energy therapy does not seek to diagnose or replace professional medical advice and should be viewed as complimentary to the healing arts.

3) All the known contraindications (situations in which an energy therapy session might not be beneficial) have been made clear to me, but I understand that energy therapy may have other possible health benefits and risks that are not yet known.

4) Everyone's treatment sessions are different and responses can very greatly and I may have a strong healing response that might require me to rest the following day. (See section below called 'After your session' for a list of known detox symptoms.)

5) Receiving a distance session could make me very sleepy or distracted, therefore I should not drive or operate heavy machinery during or straight after my distance session.

6) Some prescription medications and recreational drugs may effect my response to the session.

7) Given there are so many variables involved with energy therapy, Vanessa cannot be held responsible for any undesirable outcomes.

Do you agree to undertake the energy therapy session(s) with full understanding of the above disclaimer? *

Yes

After your session

Please read the following carefully:

Everyone's session is different and responses can vary. Most people report feeling clearer, calmer, more relaxed and self-aware immediately afterwards, but for others it takes a bit longer. Sometimes clients can experience a strong healing response such as:

The need to urinate more frequently.

Disruptions to woman's next menstrual cycle.

Tiredness or exhaustion, needing to sleep for a day or more: generally this happens with people who have been 'running on empty.'

Mood swings. Becoming emotional as the past resurfaces. Becoming aware of unhealthy behavioural patterns, thoughts and beliefs could also make you emotional.

Headaches or dizziness.

In very rare instances: skin rashes, mucus, fever, vomiting, loose stools, and excessive thirst.

These symptoms are generally a sign detoxification and will pass within a day or two. If a condition persists, it is important to see your practitioner again, sooner rather than later. Sometimes people can get stuck in the unwinding process and need an additional boost to complete the adjustments.

HYDROTHERAPY
Due to the conductive properties of water, it is beneficial to be well hydrated with water or herbal teas before and after each session. It is also recommended that you soak in a mineral or Epsom salt bath for a minimum of 20 minutes after a session, this helps support the body in detoxifying or releasing any physical components from the blockages released from the energy field.

IF YOU HAVE ANY QUESTIONS, PLEASE FEEL FREE TO DISCUSS THESE WITH VANESSA.

Email: vanessa@vanessawood.nz
Mobile: +64 21 819 434

Do you grant Vanessa permission to share her findings about your session for research and educational purposes? (Your identity and private details will be kept strictly confidential.) *

Yes

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