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Consent Form
Consent Form
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CONSENT FORM I, ________________________________________, understand that The Emotional Freedom Technique EFT™, Inverse Wave Therapy™, Reiki, Reconnective Healing™, medical intuition, and any other healing or intuitive modalities (hereinafter referred to as “Modalities”) offered by Andrea A. Zwegat have yielded measurable results for balance and well-being; however, they are still considered in the experimental stages. I further understand that any Modalities offered by Andrea A. Zwegat do not guarantee any healing or positive results to my well-being. I understand that Modalities are not a medical treatment, a cure, a diagnosis, or a prescription for treatment--natural or medically prescribed. I understand that Modalities and sessions are not a substitute for medical, mental, holistic or any other professional advice or expertise.I understand that Andrea A. Zwegat is offering her Modalities and services as an ordained minister and that she is not a licensed physician or health professional.I agree that I am responsible for my interpretation, decisions and actions regarding my mental and physical health as well as my personal life based on my experience of Modalities offered by Andrea A. Zwegat. Andrea A. Zwegat makes no representations, extends no warranties of any kind, express or implied, and assumes no responsibility or liability whatsoever with respect to the use of, accuracy of or other disposition of the information or technique provided by Modalities. Further, Andrea A. Zwegat disclaims any and all liability related to Modalities, its accuracy and/or the use thereof and I assume all liabilities and risk related to the use of Modalities.It is hereby agreed that Andrea Zwegat will not be held liable in contract or in tort for any personal injury of any nature whatsoever that arises from or is the result of Modalities, and that I assume all liabilities and risks related to the use of Modalities.I am 18 years or older and have read and understand this notice and its contents. Signed this _______ day of __________, 20____ Signature ______________________________________ Name: _________________________________________________________ Address: _______________________________________________________ Phone: __________________ email: _______________________________ Cell Phone: _____________________ I am 18 years or older and am the guardian of the child. Name of child_____________ I Would you like additional information sent to you periodically regarding upcoming workshops or events? _____yes ______no Preferred method of information delivery _____Email ______Regular Mail _____Phone Call ______ Return signed form to: Andrea A. Zwegat.
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