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Acoustic Sound Therapy Form

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Acoustic Sound Therapy uses sound frequencies and vibrations to promote relaxation, reduce stress, and enhance overall well-being.


Contraindications

Please confirm that none of the following conditions apply to you:

  • Severe mental health conditions (such as schizophrenia or severe anxiety disorders, as sound therapy may trigger discomfort)

  • Epilepsy or seizure disorders (certain sound frequencies may be a trigger)

  • Pregnancy (consult with your physician before undergoing therapy)

  • Pacemakers or implanted medical devices (sound frequencies may interfere with their function)

  • Hearing impairments or tinnitus sensitivity (consult with a specialist if sound sensitivity is an issue)


Client Acknowledgment & Consent

I have read and understood the information above. By signing below, I confirm that none of the contraindications apply to me, and I voluntarily consent to receive Acoustic Sound Therapy. I understand that this therapy is not a substitute for medical treatment and that I should consult with my physician if I have any concerns.

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Let's Chat

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123-456-7890 

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