*Please Read Carefully Prior to Signing*
I authorize Leila Tober to serve me in the capacity of Quantum Touch Practitioner, to provide energy healing work within the bounds of her certification. (Definition of Services attached)
I understand that Quantum Touch should not be construed as a substitute for appropriate medical and or mental health care. Nor does it diagnose, prescribe, or treat for any physical and/ or mental illness. Leila Tober is not a mental health care therapist, professional
counselor, licensed clinical social worker, marriage and family therapist, psychologist, psychiatrist, massage therapist or medical practitioner or nurse. Nothing she says or does should be construed as such.
I take 100% responsibility as to what to apply and/or not apply in my life regarding anything she says and/or does @ anytime and even stopping the session(s) if I feel to do so.
I take 100% responsibility for my medical and/or mental healthcare choices and all consequences resulting from those choices and/or actions taken with respect to any information received from, by or through Leila Tober.
I understand that all information received and given is kept strictly confidential. That includes with my spouse, my family and my friends, as well as Leila Tober’s spouse, her family, her friends and/ or colleagues. Leila Tober will never talk about specific issues in a way that links me with the information – though at times, Leila Tober may use my experience(s) as a completely anonymous example to help other people in client sessions, and/ or articles on the internet or elsewhere. Leila Tober may consult an associate regarding me, but only as an anonymous client. (Note: If you have any questions or concerns about this, let Leila Tober know prior to signing this document and she will accommodate you and make note of your desires.)
I have read the above statements and in no way hold Leila Tober, her family, heirs, trustees, assigns, employees, staff, or assistants responsible at any time for any actions I may take because of information shared, energy work received by myself during the energy healing session(s).
I represent and certify that my true name and identity is written above and signed below, that I am who I say that I am, and if I am under the age of 21 years, I do represent and certify that I have the permission of my parent(s) and/or legal guardian(s) to participate in the stated activities and that they have full knowledge thereof.
Furthermore, I understand that any illicit or sexually suggestive remarks and/or advances will result in immediate termination of the energy healing session(s) without any refund.
I, the undersigned have read this form completely and agree to and understand all of its contents.