Client Consent to Treat & Waiver, Release, and Assumption of Risk Form

  • Amelia Vogler (MS, HTCP/I) uses Healing Touch, hands-on or hands-off energy therapies, energetic craniosacral therapy, energetic reflexology, tuning forks, gemstones, flower essences, and therapeutic-grade essential oils (aromatherapy) to help attune and balance your energy system. Amelia also receive intuitive information for healing work, intuitive consulting, and professional mentoring. All of these therapies are a form of vibrational healing. I understand that these therapies are gentle, integrative energy-based approaches to health and healing that can assist my body in its natural ability to heal. I fully acknowledge and understand these therapies are performed by contact and/or non-contact touch. I understand that these therapies are integrative therapies not intended to replace any currently prescribed medical treatments as ordered by my physicians nor any other medical care that I have been advised to seek by them. I understand that Amelia Vogler does not hold a license to practice medicine in the state of North Carolina. I have been encouraged to consult a licensed medical practitioner for medical evaluation and treatment. I agree to be an active participant in my healing process and to take ownership over my own healing journey. I understand that intuitive coaching is not a substitute for professional counseling. I understand that any session notes are confidential and that my experiences in these sessions are confidential and subject to the usual exceptions governed by State or Federal laws and regulations. I understand that there is a 48 hour cancellation policy and if that policy is not adhered to then a $50 missed appointment fee is charged. I give my consent to receive Healing Touch, energetic reflexology, tuning fork therapy, gemstone therapy, aromatherapy, flower essences, intuitive coaching, professional mentoring from Amelia Vogler - MS, HTCP/I, Mentor. This form is an important legal document. It explains the assumption of any and all risks in deciding to follow the advice or insight from intuitive consultant Amelia Vogler, who operates as an advising consultant through The Healing Space LLC. It is critical that you read and understand it completely. After you have done so, please sign in pen or via an electronic signature. Waiver, Informed Consent, and Covenant Not to Sue I hereby acknowledge I have volunteered to participate in a paid or unpaid session, class, workshop, service or program with Amelia Vogler or The Healing Space, LLC to include, but also may not be limited to, any and all services provided, such as energy healing, vibrational medicine, intuitive coaching, guidance, readings, charts, classes and workshop attendance. In consideration of the The Healing Space, LLC agreement to instruct, assist, advise, or train me, I do here and forever release and discharge and hereby hold harmless the The Healing Space and its respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in a session or purchase or any program WITHOUT LIMITATION, WHICH MAY OCCUR AS A RESULT OF following advice tendered and released or training rendered or use of facilities during a session or event. I recognize that in no way does any member of The Healing Space, LLC provide legal, medical, or therapeutic advice and it is my responsibility to secure such advisement. I acknowledge and agree that I assume the risks associated with any and all activities, offerings, services, classes and/or programs in which I participate. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from any insight, guidance or program. I understand that results are individual and may vary. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST THE HEALING SPACE, LLC FOR THEIR NEGLIGENCE OR THAT OF THEIR EMPLOYEES, AGENTS, OR CONTRACTORS.
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