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Participant Intake Form

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We appreciate you taking the time to review this information, complete the enclosed form, and supply us with the items requested below.

Please complete this participant  Assessment form before your ceremony/class.

If the form is received on the day of our meeting, we may need to review it, which will cut into the class time for everyone!    


The United States of America has no licensing policy regarding Sound or Energy Healing, and Raven Runyan is not a licensed Medical Doctor or therapist. I do not deal with drugs, nor do I issue a diagnosis or suggest cures.

I aim to provide a safe space for my client to experience healing through natural processes. I consider using sound, energy, herbs, essential oils, crystals, and any other natural healing modality to encourage the body to get back to optimal functioning, and everyone reacts to these methods individually. I make no claims for their medicinal actions nor cite scientific evidence. Any information offered is based on personal experience and traditional uses.

My clients agree to make their own choices regarding what they do with the educational material they have been offered and are solely responsible for their own decisions and actions. It is always my recommendation to seek out the advice of a licensed healthcare professional whenever they feel it is necessary regarding their health, especially with serious conditions. Clients need to consult with their physician and get approval to attend healing sessions if they have metal in their bodies, have suffered concussions, have a pacemaker, use an insulin pump, and the like. If in doubt, please consult your physician before our time together.

Some issues, such as suicidal thoughts or life-threatening illnesses, are beyond the scope of my expertise, and I would advise you to seek outside help.

I understand that:

  • These sessions/workshops/Ceremonies cannot replace treatment by established medical practices but complement them.
  • There are no guarantees as to the results - each person will have their own experience, which will depend on how open you are to receiving when we meet.
  • Raven Runyan is not a licensed physician and will neither diagnose nor prescribe any condition nor make any specific claims regarding the results from the ceremonies received. Nothing in the work Raven does is considered the practice of medicine.

I agree to:

  • Raise any questions or concerns about anything I do not understand.
  • I take full responsibility for my health care.
  • Give consent to Raven to conduct a group session to balance my energy system. I acknowledge that this could involve touch, and I can request otherwise.
By placing an “x” in the box above and entering your name, you agree to the Cancellation Policy for this session and future sessions. This is required for any and all sessions booked.

General Health Assessment

We may incorporate sound healing and plant medicines during your class or ceremony.  Some of these modalities can interfere with health conditions, allergies, etc.  Please complete this assessment to create a class or ceremony experience that will benefit you the most instead of interfering with current health concerns.


General Health

Are you pregnant or breast feeding?

Allegies & Plant Medicine

Herbs can interfere with current medications as well as different allergies.  For example, Chamomile can trigger a reaction for those with a Ragweed allergy.  Another example is for people on blood thinners, Rosemary and Goldenseal can increase bleeding issues.  For those undergoing HIV treatments, echinacea weakens the immune system's ability to control HIV.  This information is needed to keep you safe during our ceremony or class!

Do you have allergies?


Medication or Herb Allergies?



Food Allergies?


Medication or Herb Allergies?
Food Allergies?

NOTE: If you checked any boxes above, please contact your physician and get approval for using plants & Herbs in our work! If we cannot use plant medicine, there are other modalities that we can use.  My goal is to keep you healthy and safe.

Sound Therapy & Health Conditions

Please check the box next to any of the conditions you may have below. My goal is to tune the therapy to make it safe for you and your body.

NOTE: If you checked any boxes above, please contact your physician and get approval for sound therapy before we begin our work! If we cannot use sound therapy, there are other modalities that we can use.  My goal is to keep you healthy and safe.

Emotional Checklist

Put an X next to each statement that corresponds to the way you often feel.