Client Consent & Contraindication Form

Client First Name

Client Last Name

Date of Birth

Email

Contact Number

2. Health & Safety Information 2. Health & Safety Information I understand that meditation and sound therapy can evoke emotional responses or physical sensations as part of the body’s natural process of release and realignment. I understand that this is a complementary practice and does not replace professional medical advice, diagnosis, or treatment. I confirm that I will inform the facilitator of any relevant health conditions before the session begins (including mental health conditions, epilepsy, sound sensitivity, pregnancy, metal implants, pacemaker, tinnitus, or recent surgery). I understand that if I am under medical or psychological care, I should consult my healthcare provider before participating. I understand that participation is voluntary, and I may stop or rest at any time during the session. I understand that sound frequencies and vibrations may not be suitable for everyone, and while every effort is made to create a safe environment, individual responses may vary. I acknowledge that any discomfort or emotional response experienced during or after the session is part of my personal process and that I can speak with the facilitator at any time if I need grounding or support.

3. Contraindications (Please tick if any apply) 3. Contraindications (Please tick if any apply) Pregnancy (especially first trimester) Epilepsy or seizures triggered by sound/light Severe mental health conditions (e.g. psychosis, schizophrenia) Pacemaker, heart condition, or metal implants Sound sensitivity, tinnitus, or hearing disorders Recent surgery or fractures (within last 3 months) Chronic pain or mobility concerns None of the above

4. Consent. By signing below, I confirm that: I have read and understood the information above. I take full responsibility for my participation. I release the facilitator from any liability for injury, loss, or damages that may occur as a result of participation, except in cases of proven negligence. I consent to take part in this guided meditation and sound therapy session. 4. Consent. By signing below, I confirm that: I have read and understood the information above. I take full responsibility for my participation. I release the facilitator from any liability for injury, loss, or damages that may occur as a result of participation, except in cases of proven negligence. I consent to take part in this guided meditation and sound therapy session. Yes No

Client Signature (type your full name)

Signature Date