Session Form - The Touch of Light by Helen

BIOMAGNETISM / BIOENERGETICS PATIENT FORM
NAME____________________________________ DATE_______________________
ADDRESS_________________________________POSTAL CODE_______________
HOME PHONE _________________________CELL____________________________
EMAIL_________________________________________________________________
DATE OF BIRTH________________________________________________________
Where did you hear about Biomagnetism? _____________________________________
What are your main concerns presently?
_________________________________________________________________________
_________________________________________________________________________
Conditions / major illnesses / surgeries you have had in the past:
_________________________________________________________________________
Have you had a blood transfusion or organ transplant? Yes No
Are you currently pregnant? Yes No
Are you or have you had Chemotherapy, Radiation treatments? Yes No
If Yes, when? _______________________________________
Do you have a pacemaker? Yes No
Are you taking medications, nutritional supplements, etc?
_________________________________________________________________________
I, (please print )
____________________________________________________
Understand and acknowledge that:
*HELEN BENKO, has been Certified to provide Biomagnetism Therapy by the
El Centro de Investigacion de Biomagnetismo Medico, S.C. in Mexico, the
Autonomous University of Chapingo, Mexico and by Dr. Isaac Goiz Duran.
*She is NOT a medical Doctor, she is NOT making a medical diagnosis or
providing medical advice or care.
*I should see a Medical Doctor for follow-up care, and I should view
Biomagnetism Therapy care as additional, complementary therapy to the
medical care provided by a Medical Doctor.
*Biomagnetism Therapy is NOT a substitute for Physician consultation,
evaluation or treatment.
*Biomagnetism Therapy consists of applying Medium Intensity magnets
between 1,000 and 15,000 gauss in certain areas of the body in order to help
balance the pH levels of Alkalinity and Acidity in the body.
*The number of required sessions depends on your state of health, your body
will decide whether 2 or more sessions will be needed.
I have NOT received Chemotherapy and / or Radiation Therapy within the last
year and I’m not planning on receiving such therapy within a year from now. It
is NOT advisable to have a Biomagnetism Therapy in this situation.
It is my desire to experience Biomagnetism/Bioenergetics Therapy sessions.
Signature _________________________________________________
Date_____________________________________________________
IMPORTANT INFORMATION
After a treatment, please remember to change or bleach water (or soak in hydrogen
peroxide for at least 10 minutes) your toothbrush to avoid re-infection. We never think
about what germs are on and continue to grow on our toothbrusthes!
You may or may not experience what is called a DETOX, CLEANSE, or healing crisis
following a treatment, especially the first one. Every one is unique. This is normal.
It is a process in which the body undergoes an intense period of cleansing and rebuilding.
It is called a ‘healing’ crisis because the body is healing itself and becoming stronger.
It is referred to as a ‘crisis’ because the symptoms can be flu like and dramatic and rather
unpleasant during this time.
Because the healing crisis is accompanied by unpleasant symptoms it is often mistaken as a
sickness. In reality, it is just the opposite. It is a process in which the body is overcoming ill
health and becoming healthier and stronger.
Feel free to call me, Helen Benko, if you have any questions: 519-842-7286
Be kind to yourself, drink plenty of water, minimum 1 ½ litres, (squeeze some fresh lemon
if you can) in order to flush your system. Eat lightly, fresh vegetables, fruits that have been
washed well. Avoid heavy foods, greasy, heavy meats. Rest, get some extra sleep if you
need it.
Know you are healing…