Aura Cleansing Consent and Intake Form
Personal Information
Full Name
Date of Birth
Contact Information
Health Information
Are there any current health concerns?
Are you currently taking any medications?
Session Goals
What are your intentions/goals for this aura cleansing session?
Consent
I consent to receive the aura cleansing session and understand this is not a substitute for medical treatment.
I understand my information will be kept confidential.
Signature
Date