Intake Form | Hilo Energy Therapy

First name

Last name

Date of Birth

Phone Number

Email

Reason(s) for visit

Physical Pain

Emotional Struggles

Mental Health Issue

Immune System Disorder

Respiratory System Disorder

Circulatory System Disorder

Reproductive System Disorder

Nervous System Disorder

Digestive System Disorder

Excretory System Disorder

Cancer

Epilepsy

Diabetes (type 1)

Diabetes (type 2)

Self Improvement

Spiritual Development

Sleep related

Other ailments or reasons you might have for your visit

Any additional information about yourself that might help us in choosing the best settings for the Harmonic Egg to address your specific needs

For your session, please dress comfortably and refrain from using perfume or cologne. All removable metal, including jewelry and watches, must be removed for the session. Pacemakers and other implanted metal are permissible. Hearing aids may be left in or taken out. Be prepared to relax and enjoy your session. It doesn't matter if your eyes remain open or closed, or if you fall asleep. There is a doorbell to alert the technician to any personal need that may arise during your session.