Intake Form | True North Energetics

Client Information

Full Name

Email

Phone

Emergency Contact (Optionl)

What brought you here today?

What inspired you to book this session?

Previous Experience

Have you previously received energy healing or meditation guidance?

Yes

No

A Little

If yes, what type of experience have you had?

Health & Safety

Anything we should be aware of for your safety?

Gua Sha Consent

Some sessions may include Gua Sha, a traditional technique used to stimulate circulation and release tension.

It may cause moderate to deep redness or temporary marks that typically fade within a few days.

I understand and consent to Gua Sha treatment if it is used during my session.

Photo Consent

Do you consent to before/after photos for educational or promotional purposes? Photos will not include identifying facial features without additional permission.

Yes

No

Final Consent

I understand that services provided by True North Energetics are holistic wellness services intended to support relaxation and energetic balance. These services are not medical treatment and do not replace professional healthcare. I voluntarily consent to receive services.

Crystal Reiki • Sound Bath • Energy Healing • Meditation • Gua Sha

Crystal Reiki • Sound Bath • Energy Healing • Meditation • Gua Sha