Client & Medical Disclaimer

Providence Healing Studio will provide a disclaimer which requires signature prior to services being provided

I, [Enter your full name], understand that I am responsible for my health and my health choices and that, per Federal and State Law, only a medical doctor is able to make any claims to diagnose, treat, prevent, or cure disease, prescribe prescription drugs and/or adjust my dosage of prescription drugs.

 

I understand that all information and all correspondence verbally, via email, brochure, letter, or otherwise does in no way make any claims to diagnose, treat, prevent or cure me of any ailment, affliction, suffering, or disease that I have had, currently have or will have in the future. Additionally, I understand that if I rely on any additional information related to financial decisions, relationships or otherwise, I do so at my own risk.

 

I therefore, release Providence Healing Studio, its employees, officers, owners and representatives from any past, present, or future health, financial or other liability issues that I may have. I also acknowledge that I am seeking services or products of my own free will and choice and that I was not, nor have been, forced, mislead or coerced by any statement made verbally or in writing. I understand that it is the intention of this therapy that a person is supported as a whole person for optimizing wholeness and success. I understand I will not be prescribed any prescription medications with these services, however I am encouraged to provide open communication between Providence Healing Studio and any of my doctors and/or practitioners I am currently working with.

 

I understand that Providence Healing Studio will not provide a diagnosis and by law cannot provide a diagnosis. I also understand that it is important that I know what is going on with my own body so I confirm that I have received a medical diagnosis or am under the care of a licensed physician to receive a medical diagnosis.

 

Additionally:

  • I understand that no physician-patient relationship is established through participation in energy reading and/or my relationship with Providence Healing Studio.

  • I understand that this work is not psychotherapy.

  • I understand that information regarding the energy of the body and/or _______ (specify where applicable, such as animal, health, etc ) is provided for educational purposes and that there is no guarantee of monies to be made or successes as no one is able to guarantee money and/or success.

  • I understand that this work is not medical diagnosis, medical treatment or medical advice; therefore I will not be provided prescription, treatment, diagnoses, cure or psychotherapy.

  • I understand I will be billed for the duration of the appointment, not for the amount of time scheduled.

  • I understand that I am the person who has the most influence over the energy of my body and that any services I receive is to assist me with working with my own energy.

  • Some appointments may be helpful to record for repeated listening, and some may not. If you are open to having your appointment recorded exclusively for your listening only, please initial here ____ (Initial)

 

I clearly understand and agree that all services rendered to me are charged directly to me and that I am personally responsible for payment which is due at the time of service.

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