Client Release Form

First name

Last name

Today's Date

Phone

Alternate Phone

Address

Date of Birth

Occupation

In case of emergency contact

Emergency Contact Phone

Do you have any medical conditions of any type or past accidents I should know about? If so, please state:

I understand that Biodynamic Craniosacral work often brings up emotions, sensations, and/or energies stored in the nervous system of the body, and in fact, is part of the work I agree to do with the practitioner.

I understand that Craniosacral work should not be considered as a substitute for a medical examination or diagnosis and that I should see a physician or qualified mental health specialist for any physical, emotional, or mental ailments that I am concerned about.

I understand that to miss my appointment time without 24-hour advance notice inhibits others from filling that time. Therefore, I agree to pay in full for appointments I miss with less than 24 hours’ notice to the practitioner.

I agree to hold Alison McAulay blameless for any problems that might arise as a result of my BCST sessions. I, the undersigned, have completed this form truthfully and to the best of my ability and knowledge. I have been given the opportunity to ask any questions that I have had relative to the treatment(s) and have read, reviewed, & agree to the terms of the agreement.