Sound Bath Consent and Waiver Form

​Disclaimers

• Sound baths are not medical procedures and do not cure any medical or mental health conditions. They are a form of energy healing, utilizing frequencies and sound to aid the body in its own natural healing processes.

• Sound healing is contraindicated for the following conditions, so please do not proceed with this appointment if you fall into any of the following groups:

• People with carotid stenosis or carotid atherosclerosis

• People with cardiac pacemakers, artificial heart valves, or cardiac arrhythmias, pain stimulator device/spinal cord stimulator, watch man or other electronic device.

• People with a stent or shunt 

• People with a deep brain stimulation device (DBS)

• People with epilepsy

• People who are currently psychotic or have a history of psychosis.

• People who are post-surgery, prior to suture removal, prior to full healing and closing of surgical scars

• People who are in the first 12 weeks of pregnancy

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I understand that sound healing sessions are not treatments for physical or mental health conditions and that Tracy Lake and Dana Jefferson are not  working in the capacity of a medical (physical or mental health) provider.
If I experience pain or discomfort during the session, I will immediately inform my sound therapist. I will not hold my therapist responsible for any pain or discomfort I experience during or after the session. I understand that I may experience physical sensations as a result of this sound healing session.
I understand that a sound healing session is not a substitute for medical care. I also affirm that I have notified my sound therapist of all known medical conditions and injuries. I agree to inform the therapist of any changes in my health and medical condition. I understand that there shall be no liability on the therapist’s part should I fail to notify of any conditions.

Sound Healing is contraindicated for certain medical conditions (listed above). I affirm that I have reviewed all my known medical conditions and will advise the sound therapist of these prior to the beginning of the sound session. I understand that I should see a physician or qualified medical specialist for any mental or physical ailment of which I am aware. I agree to keep the sound therapist updated as to any changes in my medical/physical conditions that might affect my ability to safely receive sound healing.

By digitally signing this release, I consent to receiving sound healing from Tracy Lake and Dana Jefferson, and hereby waive and release Tracy Lake, Dana Jefferson, and Contemplative Practices Resource Center from any and all liability, past, present and future relating to receiving sound healing from Tracy Lake and Dana Jefferson.

I affirm that I have read and understand this form and, to the best of my knowledge, I have no mental or physical health conditions that would prevent me from being a candidate for sound healing.