Inquiry

Required Preparation

There is a level of understanding that lays the foundation for engaging in mind-body positional integration. Before learning this approach, the following resources must be read and/or viewed to provide basic knowledge of this process. Once you have completed and attested to having reviewed the required materials, please complete the rest of the form and submit.

Your Information

For most people, our issues did not appear overnight but over time. Once these patterns are established, they gain strength. To break up the patterns at the root of your issue takes repetition. Once the patterns are disrupted, new healthier patterns can begin to form. To give you the best opportunity for this to occur, please commit yourself to at least 4-5 sessions.

Name

First Name

Last Name

Email

From What Town/City/State/Country

Description of Issue

Liability Waiver

Please check that you have read, understand, and agree to the following statements.

I am freely and of my own will engaging in mind-body positional integration.

I understand that mind-body positional integration is not a substitute for traditional medical treatment or medications.

I understand that mind-body positional integration does not diagnose illnesses or injuries, or prescribe medications.

I understand it is my choice to discuss mind-body positional integration with my physician.

I understand there may be therapeutic healing responses to mind-body positional integration, including short-term muscle and/or joint soreness, and release the teacher from all liability concerning my body's response to mind-body positional integration.

I understand the importance of acknowledging all medical conditions and medications I am taking, and take full responsibility for my decision to learn mind-body positional integration as a part of my current health care approach.

I understand that it is my responsibility to communicate any discomfort I may feel as I learn mind-body positional integration so helpful adjustments can be made.

I understand that I or the teacher may terminate the session at any time.

I have been given a chance to ask questions about mind-body positional integration and my questions have been answered.

Electronic Signature

By typing my name and submitting this form, I attest that I have personally completed the form and supplied true and accurate information to the best of my abiliy.