Consultation Form

Clients will be asked to complete a consultation form with the following information in advance of receiving Rahanni healing therapy.

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PRIVATE & CONFIDENTIAL

RAHANNI CELESTIAL HEALING CONSULTATION FORM

Name:

Address:

Phone number:

Email:

Date of birth:

Reason for healing:

Medical History:

Do you have a pacemaker?

Do you suffer from any of the following (please circle) 

Diabetes      epilepsy      schizophrenia

Current medication:

Doctor’s name and address:

Disclaimer: Rahanni is a natural healing modality and complementary therapy. It is not a substitute for conventional medicine. You will never be advised to discontinue any medication prescribed by a professional. Rahanni practitioners and teachers are not qualified to give medical advice.

Privacy: No information about a client will be shared with any third party without written consent.

( )I give permission for my details to be stored and used only in connection with my Rahanni healing.

Signed ……………………………………………………………… Date …………………………….