This form is designed to ensure clear communication and mutual understanding between the practitioner and the client. By signing, you agree to the terms outlined below for all current and future sessions.

Purpose of Consultation
The purpose of these sessions are to support and guide you through alternative medicine practices tailored to your individual needs, including anxiety management. Please note: These services are complementary to, not a replacement for, medical or psychological care provided by a licensed healthcare provider.

Payment Policy
All payments for sessions and consultations must be made in full at the time of the appointment unless otherwise agreed upon in advance.
Failure to make timely payment may result in cancellation of future sessions or termination of services until payment is received.

Cancellation Policy
If a cancellation or rescheduling request is made within 24 hours of the scheduled appointment, a cancellation fee of 50% of the appointment cost will apply.
Exceptions may be made in the case of emergencies, at the discretion of the practitioner.
Clients who repeatedly cancel or reschedule on short notice may be asked to prepay for future sessions.

Potential Reactions to Energy Blockage Removal
Removing energy blockages may result in mild, temporary symptoms as the body re-adjusts. These symptoms typically appear within 24 hours of the session and may last up to 4 days.
Common symptoms may include:
- Feeling slightly run-down
- Runny nose
- Sore throat
- Itchy eyes
- Symptoms resembling a mild cold
Important Note:
- These reactions are normal and indicate the body’s natural adjustment to energy shifts.
- Every individual responds differently, and while some may experience these symptoms, others may not.
- These reactions are temporary and generally resolve without medical intervention. If symptoms persist, please consult a qualified healthcare professional

Client Acknowledgment
- I understand that the practitioner is not a licensed medical doctor, psychologist, or psychiatrist.
- I understand that the services provided are non-diagnostic and aim to support overall well-being.
- I acknowledge that it is my responsibility to seek professional medical advice for any serious mental or physical health concerns.

Confidentiality Agreement
All information shared during my sessions is confidential and will not be disclosed without my written consent, except as required by law.

Client Responsibility
To ensure the best possible outcomes, I agree to:
- Provide accurate and complete information about my health, including current treatments and medications.
- Take personal responsibility for my decisions and actions following the consultation.
- Inform the practitioner of any changes in my health status that may impact the consultation.

Consent to Practices
I consent to the use of the following approaches during my consultations:
- Energy work incorporating Kinesiology methods and Chinese acupuncture points (acupoints) without the use of needles.
- Removal of energy blockages using natural remedies
- Relaxation and mindfulness exercises.
- The recommendation and use of affirmations.
- Herbal or natural remedy recommendations.
- Other alternative medicine techniques as discussed and agreed upon.
I understand that:
- The effectiveness of these practices may vary from person to person.
- Mild, temporary symptoms may occur after energy blockages are removed as the body re-adjusts.
- These practices are intended to complement—not replace—medical or psychological treatments.

Liability Waiver
I understand that results may vary between individuals and agree that the practitioner is not responsible for outcomes beyond the scope of the services provided. I agree that the practitioner will not be held responsible for decisions or actions I take based on the information provided during any session.

Consent to Proceed
By signing this form, I confirm that I:
1. Have read and understood the information provided in this document.
2. Voluntarily consent to proceed with the alternative medicine sessions and the techniques outlined.
3. Understand that this declaration applies to all current and future sessions with the practitioner, including initial and follow-up sessions, unless otherwise specified
4. Acknowledge that I have the right to withdraw consent or discontinue sessions at anytime