Sangoma Holistic Health Center

Your experiences during our sessions are confidential, and you have a right to view your client profile records upon written request. You can send an emailed request to MaelitaSimmons@sangomahhc.com or me a call at (877) 724-0663 Ext 100 for additional help.

Confidentiality is subject to the following exceptions:

·         You instruct me to release information to other health care practitioners and/or other individuals, in writing.

·         I am subpoenaed or otherwise legally obligated or reasonably allowed to do so (including circumstances where there is clear and imminent danger to yourself or another person).

·         Your confidential client profile is kept in a secure location and is retained for 5 years after you end services, after which time all information will be destroyed in a proper manner.

·         Your confidentiality is always subject to the usual exclusions dictated by state and federal laws and regulations.

I have read and understand the above disclosure regarding privacy policies and confidentiality, and that experiences during these sessions are confidential but subject to the usual exceptions governed by laws of the State of Arizona and other federal laws and regulations. 

Maelita Simmons has multiple years in the healthcare field dealing with chemically made medicines. Maelita decided to move more into natural base medicines in 2017 because of suffering from health issues since 2012. She is an energy worker, meditation practitioner/ teacher, womb practitioner, doula, holistic health coach, reflexology, Nutrient Certified, and she is attending school to become a yoga instructor. If you would love more formation in regard to her certifications and testimonies, please click here.

 

I understand that Maelita Simmons is not a licensed physician or coach, as her scope of care, at present, is unregulated, and therefore, her services are not licensed by the state of Arizona. I understand it is my responsibility to maintain a relationship for myself with a medical doctor, mental health professional, or any other essential specialized health professional if I so desire. I further understand that Maelita Simmons is not trained to diagnose illness, make recommendations involving pharmaceutical drugs or surgery, or handle medical emergencies. I also understand that the statements and services offered have not been evaluated by the US Food and Drug Administration.

 

I hereby release, waive, acquit, and forever discharge The Womb Sauna and Maelita Simmons, any agents, successors, assigns, personal representatives, executors, heirs, and employees from every claim, suit action, demand, or right to compensation for damages I may claim to have or that I may have to arise out of acts or omissions by myself or by Maelita Simmons, because of the recommendations are given or otherwise resulting from any booked sessions. I further declare and represent that no promise, inducement, or agreement not expressed in this agreement has been made to me to sign this agreement. This agreement shall bind my heirs, executors, personal representatives, successors, assigns, and agents.

 

Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless The Womb Sauna and Maelita Simmons, from and against all claims or liability of whatsoever kind or nature arising, out of or in connection with, my session(s).

Please take a moment to carefully read the following information and sign where indicated. If you have a specific medical condition or specific symptoms, reiki/bodywork may be contraindicated. A referral from your primary care provider may be required prior to service being provided. I understand that the reiki/bodywork, holistic coaching, reflexology, foot detoxing, meditating, and yoga exercises I receive is provided for the basic purpose of energy/womb healing, lifestyle changes/cleaning, and body movement. If I experience any pain or discomfort during this session, I will immediately inform the practitioner so that I can stop and/or get adjusted to my level of comfort. I further understand that energy/bodywork, holistic coaching, foot detoxing, meditating, and yoga exercises should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialists for any mental or physical ailment of which I am aware. I understand that reiki/bodywork practitioners, holistic health coaches, reflexology, meditation, and yoga teachers are not qualified to diagnose, prescribe, or treat any physical or mental illness and that nothing said during the session given should be construed as such. Because reiki/ bodywork, yoga, foot detoxing, reflexology, and holistic coaching should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I fail to do so. I also understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.

To the best of my knowledge, I am in the good physical condition and fully able to participate in these courses/ services/ sessions. I am fully aware of the risk and hazards connected with participation in said events, knowing that the associated physical activities are maybe hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in your courses/ sessions/ services.

I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Sangoma Holistic Health Center, their officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to upon the premises where the courses/services/ sessions are being conducted.

It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse if I am alive, and my heirs, assigns, and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, and CONVENTION TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the State of Arizona.

In signing this release, I acknowledge and represent that I HAVE READ THE FOREGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.

Womb Sauna Liability:

Here are recommendations for all clients of the Womb Sauna. The use of drugs, medication, or alcohol prior to or during the sauna session may lead to dizziness or unconsciousness. Please consult your physician if you are in doubt of your ability to use the Womb Sauna for health reasons. Please discontinue the use of the sauna if you feel light-headed, dizzy, or heat exhausted. Womb Sauna sessions should be limited to a maximum of 60 minutes. It is advisable to drink plenty of water before and after a sauna session. It is advised not to eat at least one to two hours prior to your sauna session to avoid any ill feelings. Clients using any medications must consult a physician or pharmacist prior to the use of the sauna. Pregnant women should consult their physician prior to the use of the sauna. Excessive body temperatures have the potential for causing fetal damage during the early days of pregnancy. Do not use any chemicals or lotions prior to your sauna session. These items may block pores and affect perspiration as well as stain the wood. By checking the agreement box below, I acknowledge and accept the risks inherent in the use of the Womb Sauna. I voluntarily assume the risk of injury, accident, or death, which may arise from the use of the Womb Sauna. I and many of my heirs, executors, representatives or assigns hereby release from all claims or liabilities for personal injury or property damages of any kind sustained while in the Womb Sauna, during the use of the Womb Sauna, and from any advice provided by an employee, independent contractor, or any representative. I agree that this intake form and Waiver is in effect for all Womb Sauna sessions and will not expire unless requested by either party.

If you have any adverse reaction to treatment or physical injury in treatment, please complete Client Incident Report Link: http://bit.ly/wsclientir within 24 hours. Thank you :)