Eight Elephants Energy LLC Client Intake Form

The following Release and Liability Waiver is effective for all visits and remote sessions:

I understand that all services provided by Eight Elephants Energy LLC are gentle, hands-on energy techniques used for stress reduction and relaxation. I understand that Energy Therapy practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Energy Therapy does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological aliment I may have. I understand that Energy Therapy can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself. I assume sole responsibility for my own health and for the results of any sessions provided by Nicole Mendoza that may affect my health in any way. Treatment(s) will not replace conventional medical diagnosis or treatment. I will continue taking medication prescribed by a licensed medical physician and will continue to follow his/her instructions. I release Nicole Mendoza and Eight Elephants Energy LLC from all legal liability during my participation in the treatment(s), as well as the locations where Nicole Mendoza offers treatments: Eight Elephants Energy, her home in Falls Church, VA, and the client's home or any other preferred locations of treatment. I understand that there are special risks involved in the use hot tub or whirlpool tub. I am aware there are potential dangers to children who are not carefully supervised, as well as any person using a hot tub or whirlpool tub too long or if a person has health risks, is intoxicated, using any kind of drugs or medication, or pregnant. I agree to waive any claim whatsoever against Eight Elephants Energy LLC its Agent, Owners or other guests of property for accidents or injury arising from use of hot tub or whirlpool tubs. I agree that I am responsible and liable for any damages that occur to the hot tub or whirlpool tub through my misuse or negligence. All information received by me from Nicole Mendoza is accepted with full knowledge that any action taken by me as a result of the information received is my complete responsibility.

A 24 hour advance notice is required when cancelling an appointment. This allows the opportunity for someone else to schedule. If you are unable to give 24 hours advance notice you may be charged the full amount of your appointment. This amount must be paid prior to your next session.

No Show – Anyone who either forgets or consciously chooses to forgo their session will be considered a “no-show.” You may be charged, in full, for this missed session. This amount must be paid prior to your next session and you may be required to pre-pay additional sessions.

Late Arrivals – If you arrive late, your session may be shortened. Depending upon how late you arrive, there may not be enough time remaining to receive a full session. Regardless of the actual length of time of your session, you will be responsible for paying the full amount of the time frame you scheduled.

I acknowledge the cancellation/no-show policy.