Quartz Sound Healing - Client Intake Form

Thank you for trusting Quartz Sound Healing with your wellness journey. Please read the guidelines below and complete this form as accurately as possible. All information you share stays strictly private and confidential.

Before You Begin: Safety Guidelines

Sound healing is a gentle, complementary practice — but like any bodywork, a few conditions call for extra care. These fall into three categories:

• Warning — a practice that can be genuinely unsafe and must be avoided.

• Caution — a condition where extra care is taken to reduce risk.

• Contraindication — a condition that rules out a particular technique because it could cause harm.

Warnings:

• Sound-induced epilepsy: Sound healing is not appropriate for anyone with sound-induced epilepsy.

• Pregnancy: Instruments are not placed directly on the body during pregnancy. Please check with your doctor before any session, and note that even off-the-body sound is approached carefully during the first trimester.

• Implanted cardiac or neurological devices: If you have a pacemaker, defibrillator, artificial heart valve, stent, shunt, or deep brain stimulation device, please get your doctor's approval first. With approval, instruments are kept at least 8 inches (20 cm) away from the device.

• Non-sound-induced epilepsy: This warrants a further discussion with your practitioner before booking

Caution:

If you have a history of severe depression, anxiety, psychosis, PTSD, or other significant mental health challenges, your practitioner will take extra care with both on- and off-body work.

Contraindications for On-Body Work:

Off-body sound remains a safe option in every case below. Instruments are not placed directly on the body if you have:

• Deep vein thrombosis (current or known history)

• Open or recently sutured wounds, until fully healed

• Acute inflammation or tumors

• Metal implants, including screws or artificial joints (avoided on and near the site)

• Carotid atherosclerosis (avoided around the neck/throat)

• Inflammatory skin conditions, including active weeping eczema

• Diseased or inflamed veins

• If you've experienced whiplash, we ask for at least three days to pass before your first session.

  
  

Have a diagnosed condition not listed here? Please check with your doctor before your on-body session.

Client Information

Health History

Lifestyle & Wellbeing

Your Sound Healing Goals

Client Acknowledgment & Liability

I confirm that the information provided above is accurate and complete to the best of my knowledge at the time of writing.

Sound healing is a complementary wellness practice, not a substitute for medical or mental health care. By checking the box and signing below, I acknowledge and agree that: I have read the guidelines and contraindications in this form and have disclosed my full health history to the best of my knowledge; sound healing carries some inherent risk, including the possibility of temporary discomfort or a healing reaction, and I willingly accept that risk; my practitioner is not a licensed medical physician or mental health professional, and this session is not a substitute for medical or psychological care; I am responsible for consulting my own doctor or a qualified professional for any medical or mental health concerns, both before and after treatment; and I release Quartz Sound Healing and my practitioner from liability for any negative effects, outcomes, or complications that may result from this session.