CLIENT REGISTRATION FORM

Academy of Sound Healing

A non for profit, International Sound Healing, Training and Research Organisation

Registration No: SO219718 under W.B. Act XXIV of 1961, INDIA
PAN: AADAA8276A
GST: 19AADAA8276A1ZU

NITI Aayog, Govt of India, Registration ID: WB/2020/0249276

All donations made to Academy of Sound Healing are exempt from Income Tax under section 80G in India.

Client Registration Form (To be filled up by Therapist)

Client phone / email id

Date

Name

Age

Sex

Chief Complaints

History of present Complaint- (Onset, Duration,Progression)

Investigation Done
YesNo

Investigation upload
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Do you see any physical symptoms of present complaints
YesNo

Pls mention the details of physical symptoms

Upload Images / Videos visible physical symptoms
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Personal History

Family History

Drug History

Previous Illness

IASH Certified Sound Therapist Name

Therapist email id

Therapist Signature