Empty Mountain

2026 Healing Wave Free Clinic

Everyone Welcome Shamanic Chinese Medicine

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Free Clinic Registration
NAME (FIRST AND LAST) EMAIL REQUIRED FOR RESPONSE PHONE REQUIRED FOR CONNECTION BACK-UP WHAT DAY WOULD YOU LIKE TO RECEIVE A SESSION? SESSION TIME
ZOOM REQUIRED FOR PARTICIPATION
I can attend via Zoom
ANYTHING YOU WOULD LIKE TO ADD ABOUT YOUR AVAILABILITY?
I WILL ONLY GIVE YOU INFORMATION THAT I FEEL COMFORTABLE IN SHARING. (YOUR OPENESS IN PARTICIPATING WILL GIVE YOUR PRACTITIONERS MORE INSIGHT IN PREPARING FOR THEIR SESSION WITH YOU.)
I Agree
PREGNANCY AGE HOW WOULD YOU CLASSIFY YOUR SESSION? 1. PLEASE DESCRIBE CONDITION AS FAR AS IS COMFORTABLE FOR YOU TO SHARE. THIS WILL HELP THE STUDENTS PREPARE FOR YOUR SESSION. 2. HOW LONG HAVE YOU HAD THIS CONDITION? 3. ARE YOU CURRENTLY UNDERGOING ANY TREATMENT OR THERAPY FOR THIS ISSUES? 4. WHAT KIND OF TREATMENT OR THERAPY (BRIEFLY)? 5. ARE YOU OPEN TO EXPLORING THE MENTAL, EMOTIONAL AND SPIRITUAL ASPECTS PERTAINING TO YOUR HEALTH AND WELLNESS? 6. ARE YOU WILLING TO SPEND SOME TIME DOING QIGONG PRESCRIPTION EXERCISES? 6. WHAT WOULD YOU LIKE TO GET OUT OF YOUR SESSION? 7. IS THERE ANYTHING ELSE THAT YOU FEEL IT IS IMPORTANAT FOR YOUR THERAPIST TO KNOW? HOW DID YOU HEAR ABOUT THE CLINIC?
I UNDERSTAND THAT THE PERSON WHO I WILL BE WORKING WITH IS NOT A MEDICAL DOCTOR AND DOES NOT MEDICALLY DIAGNOSE, TREAT OR PRESCRIBE. I UNDERSTAND THAT THIS IS A MEDICAL QIGONG STUDENT CLINIC THAT I AM VOLUNTEERING FOR AND THAT INFORMATION ABOUT THIS SESSION MIGHT BE SHARED ANONYMOUSLY AS PART OF THE STUDENT'S LEARNING EXPERIENCE.
Yes, I understand and agree
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