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Human Quantum Energy Healing Intake & Consent Form

Personal Details

Birthdate (optional)
Day
Month
Year

Reason for Session

Background Information (Optional but Helpful)

Session Preferences

Consents & Acknowledgements

Please read and acknowledge the following:

  • I understand this is a complementary, non‑medical quantum healing session

  • I consent to the practitioner accessing my subconscious or energetic field via muscle testing with the practitioner acting as a surrogate

  • I understand the session is conducted remotely and not live

  • I understand this session does not replace medical, psychological, or psychiatric care

  • I understand that multiple sessions are often required to access deeper or root causes

  • I understand that the practitioner generally recommends a minimum of three (3) sessions, with five (5) to ten (10) sessions commonly recommended for long-standing, complex, or chronic patterns

  • I understand results vary and no guarantees are made

  • I understand the session will be recorded and delivered via video, voice message, and/or PDF summary

  • I acknowledge that personal insight and integration are part of the healing process

☐ I give informed consent for this quantum healing session

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Northern Rivers NSW

Australia 2480

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