• Grieving Hearts for Animals, LLC  Informed Consent Form

  • As an ordained animal chaplain, animal grief support guide and animal intuitive, I offer grief companioning to people of all faith traditions. I hold a mindful, compassionate presence to honor the sacredness of the relationship with your animal. I am not a veterinarian and do not offer any medical evaluation or advice. I am not a licensed therapist and do not evaluate or treat any mental health conditions. I am committed to bringing my highest level of skill in providing the service of companioning you through emotional distress from anticipatory grief when your animal is terminally ill or after the death of your animal.

    I will make every effort to respectfully and compassionately help you with your situation. Understandably, grief transforms over time and, therefore, alleviation in a one-hour session cannot be expected or guaranteed. I can also offer helpful tools to assist you in your continued grief recovery to help bring comfort and support in maintaining the bond with your animal.

    Confidentiality: Anything you share with me is considered privileged information and will be held in confidence. I will not release any information about you unless given written permission by you.

    Cancellation and Refund Policy: If you need to reschedule or cancel your session, kindly give 24 hours notice. Any appointments cancelled or rescheduled more than 24 hours before your scheduled time will be refunded minus the 3% transaction fee. No refund will be given if you miss your appointment without notice or do not cancel before the requested 24 hours notice.  

    CLIENT CONSENT AND ACKNOWLEDGMENT 

    I have read and understand the above pertaining to the services to be given by Mary Ann Bumbera of Grieving Hearts for Animals, LLC. I understand that this practitioner is not a veterinarian or licensed therapist and that the comments, suggestions, or recommendations proffered in the course of the services are not to be construed as veterinary medical advice or mental health counseling. I will hold harmless Mary Ann Bumbera for any actions or results which take place based on choices I make subsequent to our discussions and acknowledge that no guarantees have been made about the outcome of this service. I agree to this service and give my consent by signing below.

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