Intake Form

Please complete the below before our session.
Thank you and I’m really looking forward to working with you.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What would you like to acheive during our session together?

Please share any information you think will benefit me in knowing before our session together. Here are some guiding questions to give some thought to: What are you looking to call in? How do you presently feel? Is there anything currently blocking you from feeling your best self? Are there any physical or emotional traumas that you are ready to release? What is your intention for the session (ie. find calm, let go of stress, etc)

Liability Waiver + Consent

I, the undersigned, understand acknowledge these classes and practices use ancient healing techniques to reduce stress, and step into my full worth. I am aware that Melaina Gasbarrino (SALT to TREE - herein ‘the company’) will not prescribe substances, perform medical treatments or diagnose conditions, nor will the company interfere with any/all licensed medical professionals. If I have any physical or psychological alignment, the company recommends seeking treatment from a licensed medical professional. I hereby agree to the following: I, the undersigned, am OK with receiving hands-on or distance energy healing through sound baths, meditation, reiki, yoga, etc. I have no medical condition(s) that would prevent my full participation in these classes. If there are any changes to my medical condition(s), I will immediately notify the company. In consideration for being permitted to participate in these classes and/or sessions, I agree to assume full responsibility for any risks, damages or injuries, known or unknown, which I might incur as a result of my participation in the companies offerings. Furthermore, I knowingly, voluntarily and expressly waive any claim I may have against the company, its owners, and instructors, for any injuries or damages I may sustain as a result of my participation. I agree that this agreement shall be governed by the laws of Ontario and if any conflict arises between me and the company, I will attempt mediation before submitting my dispute to binding arbitration. Photography and Media: By attending this session(s), you grant the company the right to capture and use photographs, videos, or other media recordings of you for promotional, marketing, or any other lawful purposes without any compensation or approval required. I have read the above release and waiver of liability and fully understand its contents and voluntarily agree to all of the terms and conditions.

First Name

Last Name

Communication Consent

I agree to the receipt of email communications, including but not limited to announcements, event invitations and newsletters, from SALT to TREE using my given email address.