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Sound Healing Booking Form

*First name

*Last name

*Email

*Phone

Birthday

Year

Month

Day

SECTION 2: Session Details

What type of session are you booking?

Group Sound Bath

Private Sound Healing

Corporate Wellness Session

Meditation & Sound Journey

Nervous System Reset Session

Couples Session

Have you attended a sound healing session before?

Yes

SECTION 3: Sensory & Wellness Awareness

*Do you experience sensitivity to any of the following?

Loud sounds

Vibrations

Crowds

Fragrances

Touch

Bright lighting

None

*Do you currently experience any of the following?

Anxiety/stress

Burnout

Sleep difficulties

Emotional overwhelm

Headaches/migraines

Fatigue

Nervous system dysregulation

Difficulty relaxing

General stress

Do you have epilepsy, seizures, severe sound sensitivity, or any condition we should be aware of before the session?

SECTION 4: Intention Setting

What are you hoping to receive from this experience?

Would you prefer a more grounding or uplifting session experience?

Grounding

Balanced

Uplifting

Unsure

SECTION 5: Consent & Policies

I understand that sound healing is a supportive wellness practice intended to encourage relaxation and nervous system regulation.

I understand that sound healing does not replace medical or psychological treatment.

I agree to inform the practitioner if I feel discomfort during the session.

I consent to my information being stored securely in accordance with POPIA regulations.

LET'S CONNECT

WhatsApp: +27 82 936 0582

Email: shenbuckus@gmail.com

QUICK LINKS

SERVICES

Crystal Healing Therapy

Corporate Wellness

JOHANNESBURG | PRETORIA

Terms and Conditions

NEWSLETTER -CLASS SCHEDULE

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Email*

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