Ear Candling Form - Feel The Heal
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1FEEL THE HEAL
Ear Candling Intake Form
Name:
Date:
Date of Birth:
Age:
Sex:
Marital Status:
Home Address:
Telephone (H)
(W)
(C)
Occupation:
email:_________________________________________
Have you had any perforations of the ear drums, surgeries, bleeding from the ears, chronic ringing in the
ears, equilibrium problems (balance) ?
Yes
No
Have you ever had ear candling performed before?
Yes
No
If yes, how long ago?
Uses of Ear Candles
Blockages from too much ear wax
Blockages due to colds, flu and ear infections
Blockages as a result of swimming, diving, surfing and air travel
Sinus problems
Headaches and migraines due to auricular pressure
Slow lymphatic circulation
Infections and blockages in the Eustachian Tube
What if I have too much wax?
Some people’s glands may produce an overabundance of wax that can be easily excreted out of the ear.
This extra wax may harden within the ear canal and block the ear. More commonly, the ear canal becomes
blocked by attempts to clean the ear using cotton wool buds, napkin corners, pencils and hair pins. This
may push the wax further into the ear canal. Wax blockage is one of the most common causes of hearing
loss.
How often should I get Ear Candling?
Ear candling is recommended for regular cleaning of the ear and to stimulate the lymphatic circulation
(immune system) via the ear canal, sinus pathway and throat for minor problems.
Use 1-2 candles per ear 2-3 times per year. For specific problems if there is no relief in 2 days, repeat the
procedure. Chronic problems may need to be treated once a week for a number of weeks. Do not use
candles for more than 6 weeks!
I understand that my practitioner is not a doctor and any therapy session, conversations used to support my
wellness do not infer or intend to diagnose, treat or cure physical, mental or emotional disorders. Do not
use candling on people who had recent surgery, perforated ear drums, implants or who have cysts or
tumors in the ear.
If a person has recurrent serious problems, they should have their ears checked by a physician before
commencing with treatment
Signature:
Date:
Submit Form
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