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Thanks for your interest in joining the
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1:2:1 

SOUND THERAPY

CASE STUDY

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please fill out this form, and I will contact you soon for an intake ZOOM call.

Date when you fill in the form
Are you participating for Chronic pain research?
Are you less than 3 months pregnant?
Do you have any metal implants, plates or other metallic items (other than tooth fillings) in your body?
Do you have seizures of any kind?
Are they Grand Mal (now known as ‘Tonic-clonic’)
To your knowledge, have your seizures ever been triggered by sound?
Do you have a severe physical or mental health condition?
Do you have mild to moderate mental or physical health condition?
If you join the case study, which months will you be available? (for chronic pain will be only in December 2024 or January 2025 )
if you join the case study, which time slot are you available?
Would you like to join my riverleaf newsletter?
Y
N
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