Tuning Fork Intake Form

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Clear choice

I understand that by signing this form I give the Practitioner permission to provide the requested service within the scope of her License or Certification. 

I understand that servides received by me from the Practitioner are for the purpose of relaxation, stress reduction, pain reduction, detoxification and energy balancing. I further understand that a tuning fork session should not be considered as a substitute for medical examination, diagnosis or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for mental or physical ailments of which I am aware.

I understand the Practitioner is not qualified to perform skeletal adjustments or diagnose, and anything said during the session should not be construed as such.

I acknowledge that I have read and understand this form. I agree to allow the Practitioner to help me learn to heal myself using the natural healing techniques and modalities available to me through this Practitioner.

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