Sound Bath and Meditation Intake & Consent Form

520-329-7085
bridget@healthylivingwithbridget.com

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Home / Sound Bath and Meditation Intake & Consent Form

Sound Bath and Meditation Intake & Consent Form

Welcome to your Sound Bath and Meditation experience with Healthy Living With Bridget. This form helps us create a safe and nurturing environment tailored to your unique needs. Please take a few moments to complete it thoughtfully. All information is kept confidential and is used only to support your well-being during your session.

Personal Information

Full Name *

Date of Birth: *

Email Address *

Phone Number *

Emergency Contact (Name & Phone): *

Health Information

I am pregnant - TrimesterI have a pacemaker or metal implantsI have epilepsy or a history of seizuresI experience vertigo, tinnitus, or sensitivity to soundI have anxiety, PTSD, or a history of traumaI have ADHD/ADDI have other health conditions or concerns

Intentions ＆ Preferences

What brings you to this sound bath today? *

Do you have an intention or area of focus for this session? *

Preferred setup:Lying downSitting

Are there any specific sounds or instruments that you dislike or #nd triggering? *

Scent Preferences or Sensitivities

We sometimes use essential oils, incense, or natural sprays to enhance relaxation. Please share any allergies or sensitivities to scents (or speci#c aromas you enjoy): *

Consent ＆ Waiver

I understand that a sound bath is a relaxation and meditative experience and not a medical treatment.
I acknowledge that participation is voluntary and that I am responsible for my own well-being during and after the session.
I release the facilitator from any liability for injuries or adverse reactions that may occur during or following the sound bath.
I consent to receive sound therapy as described.

Optional Photo/Media Consent

I give permission for photos or short clips taken during sessions to be used for promotional or educational purposes. *YesNo

Date:

Contact Information

Call Us At: 520-329-7085
Email: bridget@healthylivingwithbridget.com

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Sound Bath and Meditation Intake & Consent Form

Personal Information

Health Information

Intentions ＆ Preferences

Scent Preferences or Sensitivities

Consent ＆ Waiver

Optional Photo/Media Consent

Site Links

Contact Information