Informed Consent Agreement

Informed Consent and Hold Harmless Agreement

Please fill out the form below acknowledging you have read and agree prior to your healing session.

The Energy Healing offered by Healing Light practitioners is a gentle method used to assist the body in its natural healing process. It is not intended to replace any currently prescribed medical treatments as ordered by my physicians, nor any other medical care I have been advised to seek by them. I understand that I may stop treatment at any time, either during or outside of each session and that I am responsible for voicing any concerns regarding treatment as they present themselves, so that the practitioner(s) may address them in a timely and conscientious manner.

I acknowledge that Energy Healing performed by Healing Light practitioners is for the purpose of education, stress reduction, and balancing of body, mind, and spirit.

I understand that Healing Light practitioners do not diagnose any illness, disease, or other physical or mental disorder.

I understand that I am responsible for my own healing and acknowledge that Healing Light is offering no guaranteed results.

I have read and understood the above information and I agree to irrevocably release and waive any claims that I may now or hereafter may have against Healing Light and/or its practitioners.

I have been informed that all client information and records are treated in a confidential manner. My experiences during these sessions are confidential and subject to the usual exceptions governed by state and federal laws and regulations.

Signature

PRIVACY: Only information necessary for sessions is gathered and will never be shared with others.

NOTICE: Your session is not medical of psychiatric treatment or a replacement for medical or psychiatric treatment. Your healing session is not a substitute for medical care and is not intended to replace your physician or other medical care professional. Healing Light and its practitioners do not take responsibility for any possible consequences from your healing session, and your signature shows you have read and agree with what is stated, and that you release Healing Light and/or its practitioners from any personal liability.