: the elemental practice : intake form
Your trust is valued and any personal information provided remains strictly confidential and only used to safely tailor the session to your needs. As such, it is helpful for all questions below to be answered to your best knowledge.

In choosing to receive this holistic, complementary treatment, it is with the understanding that it is not a substitute for any acute medical treatment that might be needed and may take several sessions for any benefit to be fully noticed. Occasionally after a session, there can also be mild detoxing symptoms that arise and will likely dissipate within a day or two. You might like to read our FAQs: https://www.theelementalpractice.co/faqs 

If you are opting for an online session, do make sure you are in a space where you feel comfortable and undisturbed for the duration of our session. Sessions can be done lying down or while seated.

In filling in this form and opting in for treatment, it is with the shared understanding that any and all liability past, present and future, relating to treatment are waived for me as your therapist.
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Email *
Name *
Date of birth *
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DD
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YYYY
Phone number *
Session type *
What start timing are you looking at for our sessions (choose up to three options)? All timings are in Singapore time (SGT), UTC+8. You can check for your timezone here: https://www.worldtimebuddy.com/ *
Required
What are you hoping to get from our session together? *
Any past accidents, surgeries, traumas or injuries that feel important to share (pl describe briefly and indicate when if yes)? Also, if you might be aware of what your birth was like when you were coming into the world, you can share here too (e.g. C-section, premature, etc). *
Any recurrent experience of the following (pl check all that apply)? *
Required
What therapies or body-based practices have you explored previously? *
Required
(For in-person sessions) Would you be open to receiving touch, are there any particular parts of the body you would prefer not to receive touch at or any kind of stimulus that you would prefer not to have in our session space (scents, music, etc)? *
Is there anything else you would like me to know ahead of our session?
Your email address will be added to our mailing list which has an occasional newsletter (<once a month), with updates of upcoming events and free resources : *
Required
Thank you for taking the time to fill this in, I look forward to meeting you soon!
A copy of your responses will be emailed to the address you provided.
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