Form Submission is restrictedForm is successfully submitted. Thank you!FilterBiofield Tuning Intake FormFirst Name:*Last Name:*Age:Email:*Please tell us who referred you so we can thank them:What are your goals for our sessions together?*Please mark any of the following that may apply to you:*Active CancerEnd of LifeAcute IllnessHeart Condition / PacemakerElectrical Medical ImplantsPregnancy or planning to become pregnant Concussion or head injury in the last 6 monthsRecent broken / Fractured bones Currently taking medicationsMetal ImplantsDental AnomaliesVaricose VeinsHeavy Metal ToxicityMorbid ObesityOtherNoneIf you marked any of the above, please provide more information:Biofield Tuning Disclaimer:Biofield Tuning and its associated processes should not be relied upon as health, medical, psychological, or other professional advice of any kind or nature. Biofield Tuning is an energy medicine* method developed by Eileen McKusick, an author, researcher and practitioner, (www.biofieldtuning.com) for self-healing and wellness that uses sound waves produced by specialized tuning forks in the biofield that surrounds the human body. Energy medicine methods, such as Biofield Tuning, are designed to assess where the body’s energies are blocked, trapped, or not in harmony and then correct the flow of these energies by aligning the body’s energies to boost health and vitality. The theory of energy medicine methods is that the flow and balance of the body’s electromagnetic and subtle energies are important for physical, spiritual, and emotional health, and for fostering overall well-being. You understand and accept that when utilizing Biofield Tuning the practitioner is not “diagnosing” or “treating” the physical body, which is the domain of the medical field and other allied healthcare professionals, but instead is connecting to the energy or subtle “bodies” of the client that make it possible to manifest a change or transformation, which is then experienced directly by the client. You understand there is a distinction between “healing” using Biofield Tuning and the practice of medicine or any other licensed health care practice. Although Biofield Tuning appears to have promising emotional, spiritual, and physical health benefits, it has yet to be fully researched by the Western academic, medical, and psychological communities. Therefore, Biofield Tuning may be considered experimental and the extent of its effectiveness, as well as its risks and benefits, are not fully known. Energy medicine methods such as Biofield Tuning are considered “alternative” or “complementary” to the healing arts licensed in the United States. Further, energy medicine methods such as Biofield Tuning are self-regulated and the State of Alaska does not license, certify, or register Biofield Tuning practitioners. Energy medicine is a collective term used that refers to a variety of energy techniques, processes, and methods based on the use, modification, and manipulation of energy fields that look at imbalances within an individual’s energy system as well as the energetic influence of thoughts, beliefs, and emotions on the body.Please Sign Below:I have provided my information to the best of my knowledge, including pertinent health information and acknowledge the cautionary guidelines listed in the above check list.Signature of Client (or Parent/Guardian if client is under 18)Date* SubmitPowered by ARForms
