Harmonic Tuning Session

About You

First Name

Last Name

Phone

Is this your first session at 5th Element Studio?

Yes, first time Returning client

How did you hear about us?

Your Intention

A full 60-minute harmonic session works with your whole system — physical, energetic, and emotional. The more you can share about where you are right now, the more precisely I can tune the session to what you need.

What brings you in today? What are you hoping to shift, release, or experience?

Where are you holding the most tension or discomfort? (Select all that apply)

How You're Feeling Today

Physical discomfort level

None

High

Nervous system / stress level

Calm

High

How would you describe your energy right now?

Grounded / stable Scattered / anxious Depleted / flat Wound up / tense Emotionally heavy

Health & Safety

Do any of the following apply?

Pregnancy Pacemaker or electronic implant Recent surgery (within 6 months) Active infection or open wound Epilepsy or seizure disorder None of the above

Current medications or supplements (optional)

Anything else I should know?

Consent

Full Name (Signature)

Date

Nina will review this before your session. See you soon.

✦ Thank you — your intake form has been received.
Nina will review everything before your session. See you soon.

Something didn't go through. Please try again, or email Nina directly at nina@5thelementstudio.com.

Harmonic Tuning Fork
Session Intake

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