Release of Liability Disclaimer
LICENSING DISCLAIMER
Currently, I am completing the hours required for state licensure. As such I am legally required to provide the following disclaimer.
"I am not a licensed clinical psychologist, social worker, or a medical doctor. As such cannot provide diagnosis, nor can / bill medical insurance, and my healing services should not be considered as a substitute for clinical psychological counseling by a licensed psychologist".
PARTICIPATION
In consideration of services provided by Dr. Michael Hofrath, operating as, Body Mind Wholeness Inc. (referred to as BMW Inc. hereafter), the undersigned, being legally competent and fully authorized and empowered to do so, does hereby release, acquit, and forever discharge Dr. Michael Hofrath and BMW Inc. from any, and all actions, courses of action, claims, demands, injuries, damages, costs, loss of service, expenses and compensation, on account of any and all known and unknown personal injuries, mental anguish or agitation, and damage claims to person or property resulting from or arising out of the services provided.
CONFIDENTIALITY
Any, and all, discussions and information exchanged, or shared, with Dr. Michael Hofrath is considered confidential, privileged information. However, there are four situations in which client information may be legally shared with or without a client's permission. These situations include:
1. If children are physically, sexually abused or neglected the proper authorities must be notified.
2. In emergency situations where there may be danger to the client or others, as with homicide or suicide, confidentiality may be broken.
3. If a court of law issues a legitimate subpoena relating to a child abuse case, I am mindby law to provide the information specifically described in the subpoena.
4.If an unreported life-threatening felony has been committed, confidentiality may be broken.
The undersigned expressly acknowledges that services provided by Dr. Michael G. Hofrath, operating as BMW Inc., are in accordance with the guidelines and policies adopted by BMW Inc., whether these policies are stated or not.
The undersigned further acknowledges that the services provided by Dr. Michael Hofrath and BMW Inc. are holistic, integrative, and spiritual in nature, and are not intended to be a substitute for clinical medical treatment. I fully understand that Dr. Michael Hofrath services are holistic integrative and psycho-spiritual health related services and that he cannot diagnose or practice medicine.
WAIVER & ASSUMPTION OF RISK
I understand there are always inherent dangers, hazards, and risks involved when engaging in holistic, integrative, and psycho-spiritual mental health related services, exercises and or activities. I further understand that Dr. Michael Hofrath and BMW Inc. cannot and does not assume any responsibility for any such personal injury, including that of death.
1. I agree to assume all the risks surrounding participation in any, and all, modalities, exercises, and activities undertaken.
2. I release and forever discharge Dr. Michael Hofrath and BMW Inc. from any, and all, liability for any injury, damage, claim, cost, and expense of any nature that may arise out of, or in any manner related to any loss, damage, or injury, including death.