Research Participant Interest Form

    Your Name (required)

    Your Email (required)

    Your Phone Number

    Age

    Gender

    Preferred Contact Method

    Do you have access to a vehicle and can get to any scheduled appointments.

    Have you participated in sound healing therapy before?
    YesNo

    If yes, please describe your experience

    Do you have a history of PTSD or trauma?
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    Are you a:

    If other, please specify:

    Do you have any medical conditions or relevant history we should know about?

    Consent (required)

    Please prove you are human by selecting the plane.