Human Baseline Lab Intake Form

“Working on myself” has added more pressure

I’ve had a spiritual or awakening experience I’m still integrating

I’ve experienced kundalini activation or something similar

I seem fine on the outside but something underneath feels off

Yes — I’m currently working with someone

Yes — and I am stable and have their support to explore additional coaching

Yes — I am currently in an acute or crisis phase

Are you currently under the care of a mental health professional for an acute condition?

1. Nature of Services: I understand that Human Baseline Lab operates as a Neuro/Somatic Awareness Facilitator. I understand that these sessions focus on biological awareness, somatic softening, and nervous system self-regulation education.

2. Not Medical or Psychological Treatment: I explicitly understand that Human Baseline Lab is not a licensed medical doctor, psychiatrist, psychologist, or licensed therapist. These sessions do not involve the diagnosis, prognosis, or treatment of any medical or psychological condition, illness, or trauma disorder.

3. No Substitution: I agree that these sessions are not a substitute for professional medical advice, diagnosis, or treatment. I am advised to maintain any ongoing relationships with my licensed healthcare providers.

4. Personal Responsibility: I choose to participate voluntarily and assume full responsibility for my physical, mental, and emotional well-being during and after all sessions.

Human Baseline Lab Intake Form

Section 1 — About You

First name

Email address

Location