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Do you have a heart pacemaker fitted?

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Do you think you are pregnant?

Declaration: I have been fully informed about my therapy including the method of treatment and agree to willingly undertake to receive the healing offered by the clinic. I agree to continue to take any medication prescribed by my doctor and will not discontinue any medication without my doctor’s consent. I agree to follow all instructions given to by the practitioners and return for further treatments as suggested by the clinic. If required, I agree to stay in contact with the Ajooni Retreat via telephone, email or in person, if I have any questions regarding my therapy. No guarantee has been given that I will not relapse. For medical advice, I will consult my doctor. I am over 18 years of age. I have read the above. I agree to the terms and conditions. *