Peaceful Remedies is happy to be offering complimentary Polarity Therapy sessions to anyone diagnosed with a life altering condition AND primary caregivers.  

Polarity Therapy Program Eligibility Guidelines:

1.    People with a life altering medical diagnosis and primary caregivers are eligible for            Polarity Therapy sessions. 

2.    Six sessions are complimentary per client per year. Any sessions after that are at the cost of the client. 

3.    Polarity Therapy sessions are 60 minutes in length. 

4.    If you do not feel well or have any symptoms that may be Covid related the day of           your appointment, please reschedule your appointment.  

5.   If you are unable to keep your scheduled appointment, please notify Peaceful                 Remedies 24 hours before the appointment time info@PeacefulRemediesOswego.com.

Privacy and Confidentiality:

I understand any conversation that I disclose in regards to my health and well-being will be held as private and confidential by the Polarity Therapy practitioner and Peaceful Remedies Inc.

I further understand that my personal records and information will not be released unless I request so by giving my consent in clearly stated written form.

Understanding of the Purpose of Polarity Therapy:

I understand Polarity Therapy is a gentle techniques used for stress reduction, increased relaxation and may compliment medical or psychological care I may be receiving.

I understand Polarity Therapy does not replace traditional medical care. The Polarity Therapy practitioner does not diagnose conditions, prescribe substances, perform medical treatment nor interfere with the treatment plans of a licensed medical professional.

I understand the body has the ability to heal itself and to do so, complete relaxation is beneficial. I acknowledge that long term body energy imbalance sometimes requires multiple Polarity Therapy sessions to facilitate the level of relaxation needed.

I acknowledge that I have received, read and understood information provided to me regarding Polarity Therapy.

I agree to give 24 hour notice for appointment cancellation or rescheduling by email or phone.

I affirm I have answered all questions honestly and to the best of my ability.

I acknowledge that by signing this form, I am giving consent for this day and all future Polarity Therapy sessions received within the Peaceful Remedies Inc organization.

I affirm there shall be no liability; All Polarity Therapy Practitioners providing sessions within Peaceful Remedies Inc and the Peaceful Remedies Inc organization.

Please Note: Peaceful Remedies, Inc. does not obtain, collect or request medical information from you for the requested service. It does not assess the appropriateness of the requested service for you individually. Should you have any questions as to the whether this requested service is appropriate for you please contact your health care provider(s). Peaceful Remedies makes no claims or representations as to the efficacy of the requested service.

PEACEFUL REMEDIES WAIVER, RELEASE and INDEMNIFICATION FORM For myself, my executors, administrators, heirs, next of kin, successors and assigns.

I HEREBY:

●  Waive and release any and all claims that I may have agains tPeaceful Remedies,their directors,employees,staff,volunteers, agents and any one or more of them or their executors, administrators, heirs, next of kin, successors and assigns ("the releases") including any and all claims for damage caused by the negligence of any of them, arising out of my participation in any and all events, services, programs and its related activities, together with any costs including lawyers' fees that may be incurred as a result of any such claim whether valid or not.

●  Indemnify and hold harmless the releasees and each of them against any such claim that I or my executor,administrator,heirs, next of kin, successors and assigns may have or assert and against any costs including lawyers' fees with respect thereto.

●  I hereby acknowledge that participation in Peaceful Remedies events,services,programs and its related activities carries with it potential hazards. I therefore release Peaceful Remedies, their directors, employees, staff, volunteers, agents and sponsors of any liability resulting from injury or death during related activities.

I, the undersigned, hereby represent and agree for myself, my heirs, assigns, executors and administration as follows:

I am in good physical health or have received a doctor’s permission to participate in my chosen event, service, program and related activities.

I acknowledge the contagious nature of the Coronavirus/COVID-19.

I further acknowledge that Peaceful Remedies, its directors, employees, staff, volunteers, agents cannot guarantee that I will not become infected with the Coronavirus/Covid-19.

I voluntarily seek services provided by Peaceful Remedies and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending a Peaceful Remedies activity.

I hereby release and agree to hold Peaceful Remedies harmless from, and waive on behalf of myself, my heirs, assigns, executors, administration and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of Peaceful Remedies, or that may otherwise arise in any way in connection with any services received from Peaceful Remedies.

I understand that this release discharges Peaceful Remedies from any liability or claim that I, my heirs, or any personal representatives may have with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Peaceful Remedies. This liability waiver and release extends to participants and all those associated with Peaceful Remedies.

This release extends to every event, service, program, activity attended.