Intake Form for Energy Therapy Student Training Please enable JavaScript in your browser to complete this form.Full Name *FirstLastDate of BirthGeneral Health / Current MedicationsPlease list any health concerns or symptoms you are experiencing.What is your goal in receiving energy therapy today?Please describe any situations, challenges in life that are not working for you as well as anything you wish to bring into your life to support your vision. today? What Date Please read carefully before signing: 1. Student Practitioners: The energy therapy sessions you will receive are being conducted by students in training at the Brigitini School of Holistic Thought. While these students are supervised by qualified instructors, they are still in the process of developing their skills. 2. Nature of Energy Therapy: Energy therapy is a complementary health approach that focuses on balancing and harmonizing the body's energy field. It is not intended to diagnose, treat, cure, or prevent any disease or medical condition. It should not be considered a substitute for professional medical advice or treatment. 3. Disclaimer: The Brigitini School of Holistic Thought and its students do not provide medical advice or diagnoses. The results of energy therapy sessions can vary greatly from person to person and are not guaranteed. You should consult with your physician or healthcare provider before beginning any new health or wellness practice. 4. Risks and Considerations: While generally safe, energy therapy may not be suitable for everyone. Individuals with certain medical conditions, such as pacemakers or serious heart conditions, may need to consult with their physician before receiving energy therapy. It is possible to experience temporary side effects such as dizziness, headache, or emotional release during or after a session. 5. Client Responsibility: You are responsible for providing accurate and complete information on the health intake form. You are responsible for communicating any changes in your health condition to the student practitioner. You understand that the student practitioner is still under supervision and may need to consult with their instructor during or after your session. 6. Agreement: By signing this form, you acknowledge that you have read and understood the above information. You agree to assume all risks associated with receiving energy therapy sessions from students in training at the Brigitini School of Holistic Thought. Type Your Name *Typing your name is a signature that indicates that you have read and agree to the above.Date / TimeDateTimeSubmit