Print Name: ____________________________________________________________________________________
Address: _______________________________________________________________________________________
Phone: _________________________________________________________________________________________
Email: _________________________________________________________________________________________
Referred By: ___________________________________________________________________________________
Birthday: ________________________________________________________________________________
I am a nutritional/vibrational counselor. I am not a licensed physician, nor a chiropractor. Since California does not offer a license for clinical nutrition or for the vibrational-orientated healing arts, I hold no license in those areas. Bioenergy Balancing, however, is complementary to other healing modalities that are licensed by the state, so my work serves as a reinforcement.
Our process together will be a collaboration. I will work with the vibrational patterns that your body expresses. I will translate that information for you, as your biofield fluctuates in response to my questions about your specific emotional and biochemical system. As you fine-tune your biofield, your physical body will begin to match the new patterns and signals and reflect those changes.
My work with you is aimed to allow your body to return to its optimal function. You set the pace for achieving that. I open up avenues to facilitate the process.
I received training and certification as a Bioenergy Balancing Practitioner from its founder and creator, Priscilla Kapel, after a two year course in study. I currently work with Priscilla.
Understand that the work we will do together is not diagnostic in nature, nor is it a substitute for medical, psychotherapeutic or chiropractic care, although it will work in conjunction with and greatly enhance any and all of these disciplines.
Signed: ________________________________
Dated: _________________________________
