Pre-Session Briefing

First Name

Last Name

Email *

Phone *

Vādma is a 100% natural, polyvagal neuro-somatic healing modality.

Do you understand that you will not be administered or permitted to consume any substances or drugs at any point during the session? *

Yes

Have you ever sustained a spinal injury? *

Yes

I confirm that I do not have and am not currently experiencing any of the following:

Cardiovascular disease, atherosclerosis, hypertension, or history of stroke; active blood clots (DVT/thrombosis); arterial stent; recent heart attack or stroke; heart surgery severe or uncontrolled heart conditions (e.g. arrhythmia, heart failure); a pacemaker; active use of blood-thinning medication (e.g. Warfarin, Xarelto, Heparin); acute fever or active infection; pregnancy.

You can NOT receive a session if any of the above applies to you *

I confirm that none of the above apply to me.

Have you ever had experience with DMT containing "medicine"? (Bufo, Ayahuasca, Yopo, Changa or synthetic) *

Yes

Prefer not to say.

Have you ever experienced a significant trauma that resulted in a loss of consciousness? *

Yes

Prefer not to say.

Have you had any filler or Botox injections in your forehead within the 30 days prior to this session? *

Yes

Please confirm that you will refrain from the use of alcohol, narcotics, or any other mind-altering substances prior to the session. *

Yes, I confirm.

Are you able to extend your head back in this position comfortably, without any restriction or pain? *

Yes

Do you have a forward head posture, typically accompanied by rounded or collapsed shoulders? *

Yes

Do you have a cervical hump (often referred to as a 'dowager's hump') at the base of your neck? *

Yes

Have you ever had any teeth extracted (such as wisdom teeth or premolars)? *

Yes

Have you had any root canal treatments performed on your teeth? *

Yes

How many of your teeth have undergone root canal treatment?

Have you ever had—or do you currently have—amalgam (mercury) dental fillings? *

Yes, still there

Yes, but already removed

Do you have any dental implants?

"Which brand or type of toothpaste do you currently use?" *

Session Outcome Disclaimer

Results are not guaranteed. Psychological resistance, excessive control, fear responses, or limiting physical posture (fascia) may reduce or block the effect.

A lack of immediate effect is considered valuable diagnostic information, identifying specific areas that require focus before deeper progress can be achieved.

Yes, I understand.