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Welcome 

Welcome 

Evolve Energy Medicine New Client Form

Please read and fill out this form before your appointment and sign it. 

Evolve Consultation Form


WHAT IS ENERGY MEDICINE?


Energy Medicine is an approach that involves balancing and restoring your body’s natural energies for the purposes of increasing your vitality, strengthening your mental capacities, and optimizing your health. 

Although Energy Medicine uses the term “medicine,” it does not imply that Energy Medicine practitioners are practicing medicine. Energy Medicine is a term used by many training programs that teach people how to assess and correct for energy imbalances in the body. Energy Medicine is not a substitute for the diagnosis and/or treatment of medical or mental health conditions by a licensed health care professional. If you have a disorder that has been diagnosed by a licensed medical or mental health professional or a condition that should be evaluated by a licensed health professional, my services should be used only in conjunction with your obtaining that care. I do not diagnose or treat medical or mental health disorders, nor am I trained or licensed to do so. Energy Medicine attempts to optimize the body’s overall health and vitality, but it is not to be used instead of appropriate care from a licensed professional.


MY BACKGROUND AND TRAINING

EEM Energy Medicine Practitioner

Healing and Reiki Certified Practitioner

Yoga breath Coach Certified Practitioner

Life Coach Certified Practitioner



WORKING WITH ENERGY


In our Energy session we will be working with procedures which are designed to enhance and balance the flow of the body’s natural energies.  Energy Medicine techniques can bring disturbed energies back to a state of balance and harmony. These corrections will generally consist of various forms of light or deeper touch and of movement of my hands within your body’s energy field. If you are uncomfortable with being touched or with any of the procedures being used, please tell me immediately and I will instantly stop.

While the methods I will be using are gentle and considered non-invasive, it is possible that physical or emotional after-effects may occur after your energies have been stimulated and adjusted. In some instances, deeper pressure is used to move energies that may be blocked or congested in a particular area of the body, and this may cause some pain or discomfort. Dizziness, nausea, or anxiety are relatively unusual but not unheard-of side-effects to energy work. If any procedure is uncomfortable or leads to discomfort, please tell me at once. I will instantly stop if you request me to do so and can often provide a technique to counter the discomfort.


OTHER ASPECTS OF OUR RELATIONSHIP


I Welcome Your Questions. Please ask me questions about anything that happens in our work together. I'm always willing to discuss how and why I’m doing what I'm doing. 

Touch.  Physical contact, even in a healing relationship, can be a sensitive matter because touch can be easily misinterpreted and feel too intimate, uncomfortable, or sexual in nature. Touching in a sexual manner is unethical within a professional healing relationship and will never be a part of our work together. Many of the methods I will use, however, are likely to involve touch. The theory behind such methods is that touching or holding points can assist me and you in identifying and shifting imbalances in your energies. At such times, you would remain fully clothed, with perhaps the exception of your shoes. I would always explain ahead of time where I would touch, and you can let me know if you are comfortable with it or not. I will always honor any requests not to touch.

Complaints.  If you are unhappy with our work together, I hope you will talk about it with me so that I can respond to your concerns directly. I will take such concerns seriously and respond to them with care and respect. You are also free to discuss any complaints about me with anyone you wish. You do not have any responsibility to maintain confidentiality about what I say or do. You are the person who has the right to decide what you want kept confidential.

Birthday
Day
Month
Year

Emergency Name and Contact Number

What do you hope to gain from your Energy Medicine session?*

Your answer

Describe any problems you wish to address, please include how long you have had them, any medical diagnosis and treatments and their effectiveness*

Your answer

Please tick any of the following that are relevant to you*

I have a pacemaker

I have metal plates / screws in my body

I have Diabetes

I am pregnant

None of the above

Other:

Your Medical History - please tick relevant boxes*

Diabetes

Cancer

High Blood Pressure

Heart Disease

Stroke

Seizures

Asthma

Allergies

Other Significant Illnesses

None of the above

Other:

Please comment if you answered yes to allergies or other significant illnesses giving more details

Your answer

Please describe any major accidents or traumatic events including dates 

Your answer

Please list any medication and supplements that you take.  If you get any side effects from them - please bring them with you and we can work with them 

What makes you happy?

If you have stress in your life, how do you deal with it?

Your answer

How do you relax?

How do you take care of your body?

Anything other comments or anything else you would like to add?

Your answer


Thank you for booking a session with me, the session will be Up to 90minutes.


Payments to be made to:


BANK DETAILS

Payment to be made to Miss E L Ball

SANTANDER 

ACCOUNT NAME Miss E L Ball

ACCOUNT NUMBER 20481881

SORT CODE 09-01-29     


Ref: Your name 

Cancellation policy - 100% refund giving 48 hours notice or more before your appointment 


I understand that the Energy Medicine sessions I receive are provided for the basic purpose of harmonising my body's energies. If I experience any pain or discomfort during a session, I will immediately inform Emma .

I further understand that EEM should not be construed as a substitute for needed medical attention. EEM practitioners do not diagnose, treat or prescribe for medical conditions. Energy Medicine brings about physical improvements by impacting the electromagnetic fields that regulate the body as well as by shifting the more subtle energies described in other cultures with terms such as chakras, meridians and etheric fields.

My writing your name and date below indicates that you have read the information in this document, understand it fully, and have discussed any questions or matters of concern with me.


*

Your answer

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©2021 by Emma Ball

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