Disclaimer and Authority:
Please understand that my services balance energy and that I do not prescribe medications, diagnose diseases or take the place of conventional medicine. It is your own personal responsibility to accommodate whatever your body presents with and consult your health care provider if symptoms persist. I ask you to accept and understand, by signing this form, that I cannot give you any guarantees of success or accept any liabilty in my sincere effort to alleviate your pain and secure a better way of life for you.
My form of therapy advocates a self-responsibility model of healing which requires your participation and involvement. You are the healer of yourself, guided and supported by me as the practitioner and coach.
By signing this form you are also stating that the information given is correct. All information is strictly confidential unless you consent to me discussing it with another professional. Please only sign this form if you completely understand its contents and are totally happy to receive treatment.
By signing below you also give permission for future contact regarding related information via mail, email, facebook or phone.
With informed consent.