Consent Form

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This is an electronic consent form for services by New Earth Healing Center LLC.

Read the client section and fill out the form below.

As a Client:

  • I understand it is my responsibility to inform the therapist and refrain from any sound therapy session if I have epilepsy, seizures, osteoporosis, brittle or soft bones, a pacemaker or electrical implants, a current broken bone, or if I’m currently pregnant or breastfeeding.
  • I affirm that I have stated all my known medical conditions and answered all questions honestly.
  • I also understand that the sound therapist reserves the right to refuse to perform a session on anyone in which there is a condition for which sound therapy is contraindicated.
  • I understand sound therapy is provided for relaxation and enhancing my overall health.
  • If I experience any pain or discomfort, I will immediately inform the therapist.
  • I understand a sound therapy session should not be construed as a substitute for medical examination, diagnosis, or treatment.
  • I understand my sound therapist is not qualified to perform skeletal or muscle adjustments, diagnose, prescribe, or treat any physical or mental illness, and that nothing said the in the course of the session given should be construed as such.
  • I agree to keep the sound therapist updated to any changes in my medical profile during and between sessions and understand that there shall be no liability on the therapist’s part should I fail to do so.
  • I understand the effect of a sound session may be temporary for the benefit of pain relief and is not a guarantee of cure.

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  • Do you have any of these?
  • Tell us more about these:
  • Checking this box acts as your electronic signature
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