Life Shine Counseling and Spinal Energetics Waiver

Spinal energetics is a powerful and somatic healing modality. Because there can be

wonderful and intense emotional and physical releases, please reach out should you have

any of the following conditions. We want you to participate if possible and want you to do

so safely. Please review the information and then sign stating that you’ve received the

information and understand the potential issues.

The following conditions should not be treated by Spinal Energetics:

• Diagnosed Severe PTSD that is untreated

• Severe mental health conditions (bipolar, schizophrenia, psychosis)

• Currently taking mulitple heavy medications that greatly alters brain chemistry (anti-

depressant, anti-anxiety, antipsychotic) this is not a reference to medication taken to address mild or moderate issues

• Recent major physical injuries, fractures and/or surgeries

• Epilepsy

• History or diagnosis of aneurysms

• Major cardiovascular problems

• History of seizures

• Severe Asthma that is not controlled 

• Severe Heart disease

• Severe Heart conditions

• Hospitalization for any psychiatric condition, emotional crisis, or spiritual emergence

within the past three years

• Any other medical, psychiatric, or physical conditions that would impair or affect

their ability to engage in activities involving intense physical and/or emotional

release.

Upon consenting, I acknowledge that I will be engaging in a session(s) of Spinal Energetics

and confirm that I am of an appropriate level of health to do so and will inform the

practitioner prior to each session of any relevant and / or essential health information.

Upon consenting, I acknowledge that the practitioner has provided myself with information

(verbal and/or in writing) that details what to expect during and after a session of Spinal

Energetics. I also acknowledge that in person sessions may include gentle touch unless I have explicitly

expressed this is not allowed.

Upon consenting, I acknowledge that Spinal Energetics can be cathartic, emotional and

physical in experience and understand that touch is made where necessary to help

facilitate the release and unravelling of tension in the nervous system. Upon consenting, I

acknowledge that Spinal Energetics session(s) can result in increase in discomfort and / or

symptoms such as: headaches, increased muscle soreness, stiffness, changes of mood,

feeling fatigued, toxin release, etc. Upon consenting I agree to the practitioners’ terms and

conditions of fees, rules, and regulations.