Home Healing Modalities Aromatherapy Consultation Quantum Biofeedback Healing Spiritual Psychology Counseling Total Body Bliss Whole Being Reset Shop Essential Oils Classes & Retreats Come Back to Your Senses I Love My Body Course Divine Abundance Workshop Emerging as the Light Sedona Retreat WOTE Aromatherapy Training About Testimonials Contact Menu Home Healing Modalities Aromatherapy Consultation Quantum Biofeedback Healing Spiritual Psychology Counseling Total Body Bliss Whole Being Reset Shop Essential Oils Classes & Retreats Come Back to Your Senses I Love My Body Course Divine Abundance Workshop Emerging as the Light Sedona Retreat WOTE Aromatherapy Training About Testimonials Contact Top 10 Essences & How to Use Them for Healing, Support, and Dealing with Common Issues Name Email Yes, Please! Quantum Biofeedback Healing session questions Please answer the following questions before your Quantum Biofeedback Healing Session with Siddiqa. Full Name Email Cell Phone Full Address Date Occupation Full Date of Birth Birthplace City and State Birth Time (if known) Purpose of your session Pregnant or Pacemaker I am pregnant or may be pregnant I wear a pacemaker 24-hr cancellation notice I understand that a minimum of a 24-hour notice is required to cancel appointments. If I fail to show up for my appointment without proper cancellation, I forfeit my deposit. Informed Consent to Treatment and Care Informed Consent to Treatment and Care: I hereby request and consent to the performance of the L.I.F.E. System Biofeedback, hands-on bodywork, spiritual counseling, and the application of essential oils on my person and other procedures within the scope of Siddiqa Kristin Salter. I understand that she will exercise good judgment and always uphold my highest good and best interest. I understand that there is no implied or stated guarantee of the success or effectiveness of the above treatments. I understand and am informed that within the Institute of Loving’s bodywork and essential treatments, there is a small possibility of skin rash, headache, nausea, bruising, and/or emotional issues coming to the surface. I understand that any psycho-emotional issues that surface are my responsibility to process and handle, and if necessary, seek treatment with a licensed psychologist. I understand that my health is my full responsibility and that it is up to me to make the necessary changes to support my growth and well-being. I have read the above consent and consider this consent to cover the entire course of sessions I have with Siddiqa Kristin Salter presently and for all future visits. Informed Consent to Treatment and Care of a Minor If Applicable, Consent for Treatment of a Minor Child as deemed necessary and I authorize Siddiqa Kristin Salter to administer the L.I.F.E. System and/or essential oils as deemed necessary to Minor Child. I fully understand that there is no implied or stated guarantee of success or effectiveness of a specific treatment or series of treatments. SEND Get Updates And Stay Connected -Subscribe To Our Newsletter Name Email Subscribe
