Chakra Balancing Consent Form
Full Name
Date of Birth
Phone Number
Email Address
Address
Section 1: Understanding Chakra Balancing
Section 2: Client Declaration
I understand that chakra balancing is not a substitute for medical diagnosis or professional treatment.
I confirm that I am participating voluntarily.
I give my consent to receive chakra balancing sessions.
Additional Notes or Medical Concerns
Client Signature
Date
Practitioner Signature
Date