Genesis Bowl Intake Form · Primal Coherence

Section 1 — What to expect

The Genesis Bowl is a 36" crystal singing bowl — large enough to sit inside. You will be placed at the center of its resonance field, surrounded by sound rather than simply listening to it. Sessions are deeply relaxing and immersive. Most people report feeling calm, grounded, and deeply present afterward.

Some people experience emotional releases during or after a session — this is a normal part of the body processing and integrating the sound. Occasionally clients may feel temporarily tired or emotionally tender for a day or two afterward as the nervous system settles. Drink water, rest if you need to, and allow the integration to unfold.

Sound healing is not a substitute for medical care and is not intended to diagnose, treat, or cure any condition. If you have a medical or mental health concern, please consult a qualified professional before your session.

I understand what a Genesis Bowl session involves and that sound healing is not a substitute for medical care.

Section 2 — Contraindications

Please check any of the following that apply to you — these are not automatic disqualifiers, but Jane will need to discuss them with you before your session:

Pregnancy
Pacemaker or implanted device
Epilepsy or seizure disorder
Tinnitus or extreme sound sensitivity
Active psychosis or severe mental health condition
Recent surgery (within 6 weeks)
Active cancer treatment
Other significant health condition

If you checked any of the above, please provide more detail

I have disclosed any conditions above that apply to me and understand that Jane may need to discuss them before confirming my session.

Section 3 — Consent & liability

By completing this form you confirm that you are voluntarily participating in a Genesis Bowl sound healing session at Primal Coherence. You understand that your practitioner, Jane Savina, is not a licensed medical professional and is not providing medical diagnosis, treatment, or advice. You release Primal Coherence and Jane Savina from any liability related to physical or emotional discomfort during or after the session.

I voluntarily consent to this session and release my practitioner from liability related to physical or emotional discomfort during or after the session.

Your information

Full name *

Date of birth *

Phone *

What brings you to this session? *

Anything else your practitioner should know

Electronic signature

By typing your full name below, you are signing this document electronically. You confirm that you have read all sections of this form, that the information provided is accurate and complete to the best of your knowledge, and that you are voluntarily consenting to receive a Genesis Bowl sound healing session at Primal Coherence.

Type your full name to sign *

Date signed *

By checking here, I consent to the use of my electronic signature in lieu of an original signature on paper. I confirm all information provided is accurate and complete to the best of my knowledge.

Your submission is sent securely to your practitioner.
Remember — wear comfortable clothing and avoid heavy meals before your session.
Questions? Text (443) 254-6762.

Intake form received 🌿

Thank you — Jane will review your form before your session.
Wear comfortable clothing, arrive hydrated, and come ready to receive.
Questions? Text (443) 254-6762.