Thank you for choosing to work with me as a client.

Please review, acknowledge, and sign the following:

I am aware that BodyTalk is not about diagnosing or prescribing medications.

I agree to non-invasive touch and tapping. I am aware that BodyTalk is a system of rebalancing and discerning disconnection within the body/mind complex and that it is not attempting to replace medical treatment.
I am aware that BodyTalk is a comprehensive system and as such takes time to incorporate changes in the body. I am here for a session with Suryo as a bodytalk practitioner , and may include possible counseling, energetic balancing, NLP and light touch.
After the session, I have been advised to drink extra water and to rest if possible, as the changes from session take at least 24 hours to incorporate into the system.
I do this session of my own free will and expect Suryo to be professional and courteous to me.

Name

First Name

Last Name

Phone

(###)

###

####

Are you familiar with BodyTalk or Consciousness based energy healing?

What is your primary goal in receiving BodyTalk?

Please list your top 5 major emotional, physical, mental and energetic concerns:

Have you had any surgeries in your life?

Have you had any broken bones or torn ligaments in your life?

Have you had any major traumas in your life?

Please list any current medications and any supplements:

I have read and agree with the statements above, and answered the questions truthfully to the best of my ability. I consent to a BodyTalk Session from Suryo.

I Agree

Thank you for choosing to work with me as a client.

Please review, acknowledge, and sign the following:

I am aware that BodyTalk is not about diagnosing or prescribing medications.

I agree to non-invasive touch and tapping. I am aware that BodyTalk is a system of rebalancing and discerning disconnection within the body/mind complex and that it is not attempting to replace medical treatment.

I am aware that BodyTalk is a comprehensive system and as such takes time to incorporate changes in the body. I am here for a session with Suryo as a bodytalk practitioner , and may include possible counseling, energetic balancing, NLP and light touch.

After the session, I have been advised to drink extra water and to rest if possible, as the changes from session take at least 24 hours to incorporate into the system.

I do this session of my own free will and expect Suryo to be professional and courteous to me.