Tuning for Tension - Intake Form

Client Information

First Name

Last Name

Email

Phone

Date of Birth

Session Date

How did you hear about us?

Is this your first tuning fork session?

Yes, first time No, I've had sessions before

Primary Focus Area

Tuning forks work with vibrational resonance to help release held tension in the body. Many clients come in with chronic tightness in the shoulders, neck, and lower back, or nerve-related discomfort like sciatica. Knowing your focus area helps me set the right intention and fork sequence for your session.

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

Shoulders Neck Upper Back Lower Back Sciatica / Hips Sacrum / Tailbone Chest / Sternum Abdomen / Solar Plexus Head / Jaw Knees / Legs Feet / Ankles Full Body / General

Tell me more about the discomfort — how long have you had it, what makes it better or worse?

How You're Feeling Today

Physical discomfort level right now

None

High

Stress / nervous system state right now

Calm

Activated

What are you hoping to experience or release in today's session?

Health & Safety

Do any of the following apply to you? (Select all that apply)

Pregnancy Pacemaker or electronic implant Recent surgery (within 6 months) Open wounds or skin conditions in target area History of blood clots or DVT Epilepsy or seizure disorder None of the above

Current medications or supplements (optional)

Anything else I should know before your session?

Consent & Agreement

Full Name (Signature)

Date

Tuning for Tension
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