pbh Art Studio Wellness Session

Welcome

Thank you for visiting pbh Art Studio. My goal is to provide a relaxing wellness experience using noninvasive wellness technology in a peaceful environment.

These sessions are intended to support general wellness and relaxation. They are not medical treatment and are not intended to diagnose, treat, cure, or prevent any disease.

For thousands of years, people have used forms of heat, light, magnetism, and electricity to support health. Today, advances in technology have allowed us to deliver many of these forms of energy with remarkable precision.

This field is often referred to as bioenergetics.

Bioenergetics is the study and application of how different forms of energy interact with living tissue. Every cell in your body communicates through electrical signals, chemical messengers, and electromagnetic activity. Energy-based therapies are designed to work alongside these natural processes to support the body’s own ability to maintain balance and function.



You will complete this form in the studio before your first session.


Client Information

Name:
Date:
Date of Birth:
Address:
City:
Phone:
Email:
Emergency Contact:
Emergency Phone:


Wellness Goals

What are you hoping to gain from these wellness sessions?

  □ Relaxation
□ General wellness
□ Better sleep
□ More energy
□ Stress reduction
□ Recovery after exercise
□ Other:

Health Information

Please check any that apply.

  □ Pacemaker or implanted electronic device
□ Defibrillator
□ Cochlear implant
□ Implanted insulin pump
□ Pregnancy
□ Recent surgery within 6 months
□ Cancer treatment currently in progress
□ History of seizures
□ Metal implants plates, screws, rods, joint replacements

If yes, please describe:

Current Wellness

How would you rate today?

Energy

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Sleep

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Stress

1 2 3 4 5 6 7 8 9 10

Overall Well-being

1 2 3 4 5 6 7 8 9 10

Client
Acknowledgment

Please read each statement carefully.
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I understand these sessions are intended to support general wellness and relaxation.
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I understand no medical claims or guarantees have been made.
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I understand individual experiences vary.
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I understand these sessions are not a substitute for medical care.
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I agree to continue following the advice of my physician and other licensed healthcare providers.
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I agree to notify the practitioner immediately if I become uncomfortable during a session.
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I understand I may stop the session at any time.

Permission

I voluntarily choose to participate in a wellness session.

Signature:
Date: