Name *

First Name

Last Name

I am a valid concession card holder

In accordance with Victorian Government Standards Nurobodi sessions are available at a 15% discount rate for valid concession card holders

Yes

No

Are you currently taking any medication? *

Yes

No

Are you pregnant or attempting to fall pregnant? *

While Nurobodi sessions are non-invasive sound and light sessions it's important to ensure in your consultation process that we consider any circumstances around pregancy from a holistic perspective.

Yes

No

Are you epileptic, prone to or had seizures *

Yes

No

Are you fitted with a pacemaker *

Yes

No

Have you previously, or do you currently suffer from PTS or PTSD? *

PTS (Post traumatic Stress) | PTSD (Post Traumatic Stress Disorder)

Yes

No

Unsure