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Practitioner Disclaimer

I understand that the information contained and presented in these private Theta Healing and/or Cellular Release sessions may be useful in creating rapid and lasting changes and do hereby agree to use this information only for the purposes of self-improvement and/or to achieve a positive outcome. The power of these techniques requires care, integrity and respect for the highest intention of all individuals.

I certify that my participation in private Theta Healing and/or Cellular Release session(s) is of my own free will and I accept complete responsibility for my wellbeing at all times.

1. Christine Richards, LMP, is not a state licensed physician or surgeon. Christine Richards, LMP will NOT diagnosis or prescribe medicines or medical treatments for you or recommend that you discontinue drugs or controlled substances prescribed by an appropriately licensed practitioner. Christine Richards, LMP neither encourages nor discourages you from contacting a state licensed physician or surgeon.

2. Christine Richards is a Licensed Massage Therapist (LMP) who has studied and practiced the energy healing techniques. The fundamental theory of energy work is that the human body has energy fields that can be affected by subtle energies, focused thought and prayer.

3. Christine Richards, LMP, only administers Theta Healing and/or Cellular Release Healing to people of their own free will.

4. The prayer and energy treatments you will receive are not licensed and are alternative or complimentary to healing arts services.

5. There is no guarantee that the treatments you receive will work.

This is not traditional therapy and is not medicine. You will not be working with a doctor, psychotherapist, psychoanalyst, psychiatrist, psychologist, master of family/child counseling, master of social work or legal council. None of the processes, nor the advice you receive here substitutes for medical or legal advice, and they are neither intended as – nor should be used as a substitute for your physician’s or attorney’s role in monitoring and treating or advising you. If you are taking medication, only your doctor is qualified and authorized to advise you as to its use.

Client Disclosure

Christine Richards, LMP, provides services that are alternative and complementary to healing arts services. Each client will be interviewed, and if it is determined that the services may be of benefit, they will be provided in accordance with the education, training and experience of Christine Richards, LMP.

I, as the Client understand that although private Theta Healing and/or Cellular Release sessions may raise emotional issues, it is not intended to provide a therapeutic environment or be a substitute for ongoing counseling or psychotherapy and that any unresolved issues which may surface and which may warrant counseling, will be at my own expense.

I further understand emotional change may occur during the processes used in these private Theta Healing sessions may affect my relationships with others not involved with my private sessions. I agree to release and hold harmless Christine Richards, LMP, Essential Therapeutic Massage & Wellness Center, and any representatives or agents of Christine Richards, LMP, for the results of any portion of the private Theta Healing sessions in which I am voluntarily participating.

I understand that any personal information provided to Christine Richards, LMP, during the course of these private Theta Healing and/or Cellular Release sessions shall be held in the strictest confidence.

I understand if I am found to be unfit to participate in private Theta Healing and/or Cellular Release sessions by an agent or representative of Christine Richards, LMP, I will be notified and refunded the cost of the private Theta Healing and/or Cellular Release sessions and will be required to leave the private sessions immediately. No questions or discussions will be entered into and Christine Richards, LMP, (or their agents/representatives) will be the sole judge.

Following each Theta Healing and/or Cellular Release session: Although the services of Christine Richards, LMP, are non-invasive, you may (or may not) experience feelings of fatigue afterwards. If you do, you are advised not drive, operate machinery, or engage in activity that requires your full alertness or might be hazardous.

Limit of Liability & Total Responsibility of Client

Christine Richards, LMP, will make every effort to assist me in achieving the results and/or changes for which services are engaged. It is expressly understood that it is my sole responsibility to confirm the effectiveness of any advice or changes, and that I must do so in safety and with appropriate monitoring of my own professional advisor, physician or other licensed healthcare professional.

Christine Richards, LMP, (or her agents), offers only a perspective for my consideration. In the course of our work, the conversation may range over a wide variety of topics. I hereby understand and acknowledge that anything and everything discussed in these sessions is merely a perspective for me to consider in conducting my affairs, and any decisions regarding my life is my sole responsibility. Should I wish to seek professional advice in this regard, it is my responsibility to do so with an appropriately licensed, competent, qualified professional advisor.

Christine Richards, LMP, nor Essential Therapeutic Massage & Wellness Center cannot be held liable for any damages resulting from our sessions or work together and remuneration is expressly limited to a refund of the amount paid for services.

Sessions:

All changes to session times or dates must be made 4 hours in advance.

I agree that any recorded or written material included in private Theta Healing and/or Cellular Release sessions is the sole possession of Essential Therapeutic Massage & Wellness Center and may not be reproduced, used or transferred in any way without the written approval of Christine Richards, LMP. As a participant, I AGREE NOT to record this Theta Healing and/or Cellular Release session or any part thereof.

I have read and received a written copy of this Disclosure Form. I understand the contents of this form and voluntarily choose of my own free will to receive the energy treatments as described above.

Liability Release for Christine Richards, LMP, and Essential Therapeutic Massage & Wellness Center

Please complete this form before your first session.

Your Name (required)

Your Email (required)

I give Essential Therapeutic Massage & Wellness Center permission to send me emails. YesNo

City (required)

State (required)

I certify that I am 18 years old or over and have read and received a written copy of this Disclosure Form. I understand the contents of this form and voluntarily choose of my own free will to receive the energy treatments as described above. YesNo

I fully understand and have chosen a Theta Healing and/or Cellular Release practitioner that speaks a language I am fluent in. I am able to read English or have had a translator read this agreement to me. YesNo

I fully understand all session purchases and session packages are NON-REFUNDABLE. Sessions expire one year from date of purchase. Paid sessions can be transferred to another as credits to be used for sessions or classes. YesNo

I understand and agree to hold harmless Christine Richards, LMP, & Essential Therapeutic Massage & Wellness Center YesNo

Theta Healing and/or Cellular Release is a supplement to medical care, not a substitute for it. If you believe that you have significant health issues or are currently in need of medical care for any reason, we recommend that you consult a doctor as soon as possible.

Essential Therapeutic Massage and Wellness Center requires that you certify your application by submitting an electronic signature. By typing your full name below and clicking Confirm Signature, you certify that all the information in the application and your signature is accurate and true.

Signature:

We respect your privacy. Essential Therapeutic Massage & Wellness Center shall use the information that you provide in this form only for the purpose of contacting you to discuss activities that are provided or sponsored by Essential Therapeutic Massage & Wellness Center. Please provide your complete and accurate contact information so we can coordinate with you on various issues, such as getting you registered for your session, confirming your appointment, and notifying you with regard to any cancellations or rescheduling issues. Essential Therapeutic Massage & Wellness Center will not sell or transfer any personal information obtained through, or as a result of, this form to any third party for any reason, unless required by law, a subpoena, or a court order.

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