Thrive Community Acupuncture (THRIVE) Energy Work Policy Agreement:
I declare that the information I have provided is correct to the best of my knowledge.
I understand that information submitted to THRIVE is held in strict confidence and will not be released without my written consent.
I understand that the representatives of THRIVE do not claim or imply that services, advice, suggestions either in person, through email or telephone will cure or prevent any disease or condition.
I acknowledge that the representatives of THRIVE recommend that I remain on any and all prescriptions that I may be taking at present and continue with current medical care.
I further declare that my healthcare is my responsibility and that THRIVE is not accountable for any consequences of my decisions regarding my healthcare.
I understand, acknowledge, and voluntarily accept the risk associated with any services, use of your facilities, and I hereby release you (including our affiliates, agents, and employees) from liability for any injury or claim (including, without limitation, personal, bodily, or mental injury, property damage or economic loss), which may result from my energy work sesssion(s), my failure to disclose any pre-existing condition, limitation or sensitivity, or my failure to inform my therapist of discomfort during my session.
Our therapists agree to adhere to a strict code of conduct designed to provide a safe, professional, and therapeutic environment for our patients and staff. In a professional relationship sexual intimacy is never appropriate and should be reported to the Director of the Division of Registration in the Department of Regulatory Agencies.
Payment and Appointment Policies:
I understand that I am responsible to pay for my scheduled appointment in full when the appointment is made.
If I miss an appointment without giving at least 24 hour notification, I understand I will be billed the full session rate.
My signature below indicates that I have read, understood, and agree to the terms as stated by THRIVE.