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Kundalini Activation Intake Form

Do you understand that it is advisable to see a qualified doctor if you suffer from a physical, mental or emotional problem?
Yes
No
Do you understand that a professional Energy Healer / Kundalini Activation Facilitator will not diagnose or recommend any form of treatment.
Yes
No
Do you take full responsibility for your own Healing Journey and agree that this session is not therapy and a replacement for medical treatment with a doctor.
Yes
No
Do you take full responsibility for your state of health. Especially , in the case of suffering from any mental, cardiovascular , respiratory, nervous, osteo-articular or other illness or disorder that may involve a risk, I must inform Serenity Piya
Yes
No
Do you understand that Kundalini Activation IS NOT SUITABLE for anyone with High blood pressure, Diagnosed Severe PTSD, Severe mental health conditions (bipolar, schizophrenia, psychosis)?
Yes
No
Do U understand that Kundalini Activation IS NOT SUITABLE for anyone currently taking heavy medication that alters brain chemistry (anti-depressant, anti-anxiety, anti-psychotic)?
Yes
No
Do you understand that Kundalini Activation IS NOT SUITABLE for anyone with Detached Retina, Recent physical injuries, fractures and/or surgeries, Epilepsy, History or diagnosis of aneurisms?
Yes
No
We recommend that you eat light foods after an Activation. This is to limit purging possibilities. Can you commit to that?
Yes
No
We recommend that you fast 3-4hours before your Session & water hydrate properly before your Session, can you commit to doing that?
Yes
No
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