Please select which option relates to yourself
Please email a photo of yourself to firstname.lastname@example.org
Part One: Health
Please answer all questions honestly and to the best of your ability.
Part Two: Pain Levels
Please list areas of pain and best describe the level of discomfort on a scale of 1 to 10.
1. Slight awareness of discomfort.
2-3. Awareness of discomfort as an aggravation.
4-6. Pain is strong but you are still functional.
7-9. Pain is so strong you are unable to function normally.
10. You feel like you need to go to the emergency room.
Part Three: Consent
By filling the information below, I accept and understand the following:
I understand that the PaRama BodyTalk session provided by Angie Tourani is intended to enhance relaxation, increase communication within areas of the body, and to educate me to possible energetic or emotional blocks that may create pain and disease.
I acknowledge that BodyTalk is non-invasive, safe and objective. It utilizes the body's own innate intelligence to re-establish communication within itself.
I understand that the BodyTalk System is not a substitute for medical treatment or medication.
I am aware that the BodyTalk practitioner does not diagnose illnesses or diseases nor does the practitioner prescribe medication.
I understand that all information shared during the session is educational in nature and is intended to help me become more familiar and conscious of my own health status and is to be used at my own discretion. It is confidential and is treated as such.
By providing this consent, I am assuming full responsibility for my BodyTalk sessions and hold harmless both the practitioner and the facility / location where the session is provided.
I understand that I may experience so-called "detoxification symptoms" or releases during the next 24-72 hours following a session and that these may be somewhat uncomfortable, particularly if I have been experiencing chronic or heightened levels of stress.