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Reconnective Healing & Personal Connection Intake Form 

Regina Fridkin, Ideal Alignment, Inc. The Reconnection, LLC. and anyone associated with this work, inclusive of, but not limited to The Reconnection® and/or Reconnective Healing ®, make no specific

claims, promises or guarantees, and are neither diagnosing nor treating any specific health challenges. You are solely responsible for seeking and continuing your medical care with appropriate licensed healthcare providers. Please do not change or discontinue any medical therapy without first seeking the advice of your licensed physicians. When providing this work, Regina Fridkin is serving SOLELY as your Certified practitioner of Reconnective Healing® and not as your medical provider. Dr. Pearl endorses only those people whom he has specifically authorized to perform this work. Authorization may be verified through Dr. Pearl’s office. I have read and understood the above.

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