Afro Fusion Energy Support

Please sign waiver prior to your session.

First Name

Last Name

Date of Birth

Have you ever had a energy work session before?

Yes

Are you sensitive to touch?

Yes

If you answered yes to any question, please elaborate

I understand that Afro Fusion Energy Support is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that that is does not diagnose conditions, nor do they prescribe or perform medical treatments, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Afro Fusion Energy Support does not take the place of medical care. It is recommended that I see a licensed physician or a licensed health care professional for any physical or psychological ailment I may have. I understand that Afro Fusion Energy Support can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.

PLEASE AGREE BY TYPING “YES” BELOW

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I declare that the info I’ve provided is accurate & complete

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