What is the reason for the consultation? Please mention all symptoms.
Since when?
Do you have a diagnosis? If yes, please explain.
Are you receiving a complementary or alternative modality (physiotherapy/other types of energy healing/acupuncture/etc.)? If yes, please explain.
Are you taking any medications or natural supplements? if yes, please mention it.
Do you have any surgical history? If yes, please explain.
Have you ever had health problems in the past (heart attack/paralysis/etc.)? If yes, please mention them.
Do you have problems with the digestive system (indigestion/vomiting/diarrhea/contipation/high cholesterol/ETC.)? If yes, please explain.
Do you have problems with the respiratory system (asthma/sinusitis/ETC.)? If yes, please explain.
Do you have any problems with the nervous system (numbness/facial tics/ETC.)? If yes, please explain.
Do you have problems with the urinary system (urinary tract infection/kidney stones/ETC.)? if yes, please explain.
Do you have a problem with the reproductive system (myoma/ovarian cyst/ETC.)? If yes, please explain.
Do you have a problem with the muscular system (osteoarthritis/low back pain/torticollis/ETC.)? If yes, please explain.
Do you have a problem with the muscular system (osteoarthritis/low back pain/torticollis/ETC.)? If yes, please explain.
Do you have skin problems (eczema or dermatitis/skin allergies/ETC.)? If yes, please explain.
Do you have problems with the endocrine system (diabetes/hyperthyroidism/ETC.)? if yes, please explain.
Do you have cancer or a history of cancer? if yes, please explain.
Do you suffer from stress/anxiety/depression or a psychiatric disorder? if yes, please explain.
How is your energy level?
By participating in our pranic healing and wellness services, I understand and agree to the following:
I understand that the services offered by Point Lumière are complementary approaches to traditional medicine and are not intended to replace it.
I acknowledge that Point Lumière does not make medical diagnoses or prescribe medications or medical treatments.
I understand that my participation in these services is voluntary, and I consent to receiving pranic healing or wellness treatments.
I understand that session results may vary from person to person and that there is no guarantee of complete recovery or specific results.
I release Point Lumière, its practitioners and its staff from any liability for any damage or injury resulting from my participation in these services.
I agree to inform the practitioner of any pre-existing health problems or any ongoing medical treatment before the session begins.
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