Tune Within

Name*

First NameLast Name

Address:*

Telephone:*

Email Address:*

Date of birth:*

Sex:*

malefemale

How did you hear about me?*

Occupation-(this will help me to understand what kind of stress if any you might have at work)*

Do you suffer from any of the following?(tick if yes)*

General health/immunity*

GoodAveradgePoor

Stress Levels*

HighMediumLow

Do you find time to relax and hobbies*

OftenSometimesNever

Energy Levels*

HighMediumLow

PLEASE READ AND TICK BELOW TERMS AND CONDITIONS TO ACKNOWLEGE THAT YOU AGREE FOR THE SESSION TO GO AHEAD:

Terms and conditions:*

I give my consent for the treatment and conform that all of the information I have given are correct. I understand that complementary therapist does not diagnose and does not prescribe any medical treatments or medication. The Holistic Massage is not to be used as a substitute for medical examination or diagnosis and it's recommended that I see a physician for any aliments that I might have. I do understand that an Holistic Massage is combined with an Energy Healing and it work on a deep energetic level and sometimes after session I might feel a bit tired or an old emotional issue can come up to a surface for them to be dealt with it. I will come to a session with an open mind and will follow an additional exercises and tools to help me with a self healing process. I will treat Anna Bojaryn with a respect and won't misbehave in any way, or will make her feel uncomfortable. In any case of any kind of abuse or harassment I do understand that Anna Bojaryn has a right to stop a session and inform a higher authorities.In a case of a cancellation for a session in person, I will give a minimum of 24 hours' notice. For late notice cancellation fee- is charged for half amount of the treatment price. I understand my details will be kept safe and will not, at any point before, during or after treatment, be shared with a 3rd party. GDPR Act from 2018.

Signature*

Date*

Date

Holistic Massage Consultation Form