Extract from Client Consent Form:
I consent to treatment for myself (or my minor child) and understand that the services provided by the Lotus Petals Therapy practitioner are intended to enhance relaxation and increase communication within my body.
I understand that these services are not a substitute for medical treatment or medications. I am aware that diagnosis is not given and medication is not prescribed. I agree to continue to have regular medical check-ups as part of my overall health care plan.
I understand that participation is voluntary and that at all times I may choose to end my participation. I understand that I may experience 'healing reactions’ during the 24 to 48 hours following the services provided.
I understand that any information exchanged during any session is educational in nature and is to be used at my own discretion. I also understand that any information imparted during these sessions is strictly confidential in nature and will not be shared with anyone without my written permission. I do, however, give the practitioner consent to use my case history and results without using my name. I understand that only the practitioner, Lotus Petal Therapy, will have access to information in my file to enhance my healing.
I agree to pay for distance or virtual sessions, should I request them. I understand that by providing this informed consent I am assuming full responsibility for my services and I hold harmless both the Lotus Petals Therapy practitioner and the facility/location where the services are provided.
Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Lotus Petals Therapy or (its agents from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).
I agree to the terms and conditions set out by this consent form and related terms as outlined in disclaimers which can be referenced at www.lotuspetalstherapy.com.
I also certify that the above information is true and correct.
Updated: 4 January 2021
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