Let's Tune In: Your Sound Healing Session Consent Sydney (New South Wales) Melbourne (Victoria) Brisbane (Queensland) Perth (Western Australia) Adelaide (South Australia) Canberra (Australian Capital Territory) Hobart (Tasmania) Darwin (Northern Territory) Newcastle (New South Wales) Gold Coast (Queensland) Sunshine Coast (Queensland) Geelong (Victoria) Townsville (Queensland) Cairns (Queensland) Wollongong (New South Wales) Toowoomba (Queensland) Launceston (Tasmania) Ballarat (Victoria) Bendigo (Victoria) Alice Springs (Northern Territory) Broome (Western Australia) Geraldton (Western Australia) Select the city New South Wales Victoria Queensland South Australia Western Australia Tasmania SELECT THE STATE How would you rate your average stress level? Please choose the option that best represents your typical level of stress. Low Medium High Severe Extreme What are some things in your life that cause you stress or make you feel overwhelmed? Who or what do you turn to for emotional support during stress ? What are the tools and resources you have in the relation to support ? Do you currently have a doctor who is taking care of your medical and psychological needs? Are you currently in any medications? If yes, please write them down. Have you ever been hospitalized or had any surgeries in the past? Are you currently receiving therapy or counselling from a psychiatrist or psychologist? Have you ever seen a psychiatrist or psychologist in the past for your mental health? Have you ever been hospitalized for mental health treatment or psychiatric care? Are you currently using or have you been prescribed any medication for your mental health? Can you tell us about any difficult or challenging experiences you've had in your life? They could be physical, emotional, or psychological in nature Have you experienced any trauma that has been passed down through generations in your family? Please tell us about your birth experience. For example, whether it was a vaginal birth, c-section, or if there were any specific circumstances during pregnancy or birth Have you experience any trauma during your early childhood ? Do you have a history of epilepsy or have you ever had seizures? Do you currently have or have you ever had glaucoma or a detached retina? Do you currently have or have you ever had any significant heart diseases or conditions including abnormal heart rhythm, passing out/syncopal episodes? Do you currently have high or low blood pressure? Do you currently have osteoporosis or a history of osteoporosis? Do you currently have asthma or a history of asthma? Do you currently have or have you ever had an cerebral aneurysm? Have you experienced a stroke in the past? Are you currently taking any medication for blood thinning or clot prevention? Have you ever received a diagnosis of bipolar disorder or schizophrenia? Have you been admitted to a hospital in the past 10 years due to an emotional crisis? Have you ever experienced or currently experience PTSD? Have you sustained any injuries lately, such as sprains, strains, or fractures? Did you use any recreational drugs or natural remedies in the past week? Have you faced or are you currently dealing with addiction problems? What are your expectations and desired outcomes for today's sound healing session ? Do you currently have a doctor who is taking care of your medical needs? How did you find out about us? What's your occupation or profession? Can you tell me more about your job,work or the service you provide? Do you practice meditation or have any self-care routines? If so, what do you do and how often? TERMS AND CONDITIONS I authorise this Himalayan Sound Healing Sydney to perform the sound healing session for myself. I authorise the use of sounds and equipments by Himalayan Sound Healing Sydney to my body. I acknowledge that this therapy has no sexual intent and touching the therapist is strictly prohibited. I understand that Sound Healing is not a substitute for medical treatment or addressing any disease or disorder. I/we understand that the exercise and instruction provided are not a substitute for medical advice, diagnosis, or treatment, and may not be safe for certain medical conditions. By purchasing this ticket, I/we affirm that, if necessary, a licensed physician has confirmed our fitness to engage in such activities. I/we will inform the instructor of any medical conditions or physical limitations before class. If I am pregnant, become pregnant, or am post-natal or post-surgical, I/we confirm that a physician has approved participation. I/we acknowledge that I/we do not have any heart conditions such as hypertension, low blood pressure, low heart rate and pacemaker in the heart. I/we do not have epilepsy and brain aneurysm or any other cerebrovascular disease and all information I/we provided in this form is true and accurate. I/we also acknowledge that deciding to engage in any exercises is my/our responsibility and at my/our own risk. I/we agree to release and waive any claims, current or future, against the Himalayan Sound Healing Sydney team, its facilities, and premises for personal injury or negligence. The facility and instructors are also not responsible for any loss or damage to personal property. By purchasing this ticket, I, along with anyone for whom I am purchasing, acknowledge that participating in physical activities carries inherent risks, including the possibility of injury, which cannot be completely avoided. If any pain or discomfort arises, I/we will stop the activity, listen to my body, and seek assistance from the instructor. I/we accept full responsibility for any potential damages resulting from participation. If any part of this waiver is found to be invalid by a court, the rest of the agreement will still apply in full, with the invalid section removed. I understand that no personal or identifying details other than visual/audio content of the session will be shared. I/we have carefully read, understood, and agreed to the terms of this Liability Waiver Agreement. I understand that purchasing this ticket constitutes a complete and unconditional release of all liability to the fullest extent permitted by law and that it cannot be altered orally. I give my consent to Himalayan Sound Healing Sydney to take photographs and/or video recordings of my sound healing session. I understand that these media may be used for promotional purposes, including but not limited to social media platforms, the clinic's/centre's website, and other marketing materials. I understand that no personal or identifying details other than visual/audio content of the session will be shared. I hereby accept all the terms and conditions outlined above, and I acknowledge that this checkbox serves as my electronic signature. Send
