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Sound Healing Research Study Waiting
Full Name
*
Email
*
City
*
State/Province
*
ZIP / Postal Code
*
Phone Number
*
Age
*
Gender
Male
Female
Preferred Contact Method
Email
Phone
Either
Do you have access to a vehicle and can get to any scheduled appointments?
*
Yes
No
Have you participated in sound healing therapy before?
*
Yes
No
If yes, please describe your experience:
Have you been affected by trauma, anxiety, or stress?
*
Yes
No
Are you a:
*
Veteran
Active Duty Military
Police Officer
Firefighter
Paramedic/EMT
Other First Responder
If other, please specify:
Do you have any medical conditions or relevant history we should know about? (Optional)
Consent (required)
*
I agree to participate in the study and provide my data as part of the research.
I agree that if accepted in the study I will complete all parts of the study, attend all scheduled sessions on time, and understand my participation is voluntary. I can withdraw at any time.
Submit
