Lucinda Curran, Life Coach and Sound Healer - logo

Intake Form

Hi!

I am so glad to see you here!

It is essential that I understand anything that needs to be considered for your wellbeing so that I can adapt what I do to meet your needs.

Please take a moment to complete this intake form so that I can fully support you in our time together.

Thank you!

 Lucinda

Lucinda Curran... LucindaCurran.com
Intake Form for SH and In-Person Events
Name
Name
First
Last
Are you currently taking any medications or supplements?
Do you have epilepsy?
Have you had whiplash or any other injuries in the last 7 days?
Are you or could you be pregnant?
Do you have any metal plates or implants?
Do you have deep vein thrombosis (DVT) or any known thrombi?
Do you have any acute inflammation or tumours?
Do you have carotid atherosclerosis?
Do you have eczema, psoriasis or inflammatory skin conditions?
Do you have a cardiac pacemaker, artificial heart valves, heart arrhythmia, stent or shunt?
Do you have a deep brain stimulation device (DBS)?
Do you have any allergies or sensitivities that may impact on our time together?
Is there anything in terms of your culture or religion that you would like me to know so that I can ensure you feel fully supported?
Out of 10 (with 1 being low and 10 being high)
Out of 10 (with 1 being low and 10 being high)
Out of 10 (with 1 being low and 10 being high)
Out of 10 (with 1 being not so good and 10 being ideal)
Out of 10 (with 1 being low and 10 being high)
Out of 10 (with 1 being low and 10 being high)
What would you like to work on or address?