New Clients

Thank you for your outreach. From this point forward, our work together has begun. In order keep an accurate record of each client, I ask that the following form be completed before our first session. Be intentional and take the time to contemplate your responses.

A few preparatory items in advance:

- Please wear comfortable clothing with the ability to access your stomach, as this practice has a focal point in the energy center in and around one's navel

- Please refrain from consuming food or liquids 90 minutes prior to the session. Limited caffeine intake is recommended to the degree you are comfortable.

- Before we meet, please contemplate your intentions for the session. If you wish to share this with me when you arrive, please do, but also know that it is not obligatory.

- Please feel invited to bring any items you wish to include on an altar while we work together.

Treatments are $350 per session. Should you be undergoing a financial hardship, I ask that you contact me to discuss alternative options.

If you need to cancel, I respectfully request a minimum of 24 hours notice in advance. Missed appointments will be charged the cost of a session.

Should you have any questions, don't hesitate to ask. I look forward to our continued work on the path ahead.

Please complete the form below in its entirety.

Name

First Name

Last Name

Phone Number

(###)

###

####

Email

Home Address

Date of Birth

MM

DD

YYYY

Desired Days / Times

Treatments are offered mornings and evenings during weekdays as well as Saturdays from 10am to 1pm. Please indicate your preference(s) below and available times will be shared with you via email.

Weekday Mornings

Weekday Evenings

Saturday Morning

Saturday Afternoon

Occupation

Current Medications / Supplements

History of Injuries / Surgeries / Allergies / Disease(s)

Present Area(s) of Focus / Intention(s)

Agreement

This work is a holistic and integrative approach to identifying and correcting energetic imbalances in the human body. The energetic medicine relayed in a session is focused on creating the optimal state that allows the body to heal itself naturally and quickly. When the body is put under stress that it is unable to handle, it will try to protect itself by shutting down, compensating, and / or showing pain or weakness. In order to correct this dysfunction, muscles, meridians, organs, neurological systems, chakras, nutrition, and hydration all play a key role in getting the body working properly. When the energy systems are restored and the body is brought back to harmony, pain and dysfunction dissipate. The undersigned understands and agrees that during the visit he/she is not receiving physical therapy, massage therapy, or chiropractic work, or spinal manipulation. This work does not claim to diagnose injury or prescribe medical treatment. The undersigned acknowledges that this work focuses on treating the body’s energy systems through touch. This palpation treatment may feel tender at times and some of the side effects can include muscle soreness, and or fatigue after a session. The undersigned understands that all bodywork offered is of a strictly nonsexual nature. The undersigned confirms that he / she has read the waiver, has discussed any pertinent health history in advance of the session and is receiving this treatment at his / her own risk. By signing this release, the undersigned does hereby waive and release Michael Ventura from any and all liability past, present, and future relating to the treatment.

I agree to the above