Client Liability Waiver & Informed Consent Form

I understand that these services are offered within a holistic, energetic, and well-being-oriented framework. These services are complementary in nature and not intended as a substitute for medical care.

By signing this document, I confirm that I am voluntarily choosing to receive these services and take full responsibility for my participation and well-being.

1. Ayurvedic Herbal Body Treatments & Medicine

• I understand that these treatments may include warm oils, herbal applications, compresses, or scrubs applied directly to the skin.
• I will notify the practitioner of any skin sensitivities, allergies, or medical conditions.
• I understand that handcrafted herbal remedies are not FDA-evaluated and are provided for wellness support. I accept responsibility for their use.
• I will consult my healthcare provider before using internal herbs if I am pregnant, nursing, taking medication, or managing a health condition.

2. Breathwork

• I acknowledge that breathwork can bring up strong physical or emotional responses and may not be suitable for everyone.
• I will disclose if I have heart conditions, epilepsy, pregnancy, high blood pressure, mental health diagnoses, or trauma history.
• I understand that I may experience dizziness, tingling, emotional release, or altered states, and I will honor my own pace.

3. Somatic Movement

• I understand that somatic movement is an intuitive, body-led practice and is not physical therapy or psychotherapy.
• I take responsibility for modifying movements and listening to my body’s needs throughout the session.

4. Reiki Energy Healing

• I understand that Reiki is a gentle, non-invasive energy healing practice, offered through light touch or hands-off technique.
• Reiki is not a clinical therapy, nor does it treat medical or psychological conditions.

5. Marma Therapy with Tuning Forks

• I understand that Marma therapy involves stimulation of subtle energy points, sometimes using tools like tuning forks for vibrational support.
• I will disclose any discomfort or areas of sensitivity and understand that results may vary.

6. Sound Healing

• I understand that sound healing may involve exposure to vibrational frequencies that affect my energy and nervous system.
• I may experience emotional release, physical sensations, or altered states during or after the session.
• I take responsibility for communicating any sensory or emotional sensitivities beforehand.

Confidentiality & Communication

I understand that all personal information shared during my sessions is held in strict confidentiality, unless disclosure is required by law for safety or legal reasons.

I agree to communicate openly and clearly with my practitioner, and to express my needs, boundaries, or discomfort at any time during a session.

I understand that there may be pictures or video taken during the session for purposes of use which may include social media or any type of advertising or promotion. If I do not consent to the use of media, or have any questions, I will clearly make the facilitator aware prior to the session.

Health Disclosure & Responsibility

I certify that:

• I have disclosed all relevant medical conditions, medications, allergies, and personal limitations.
• I am not under the influence of alcohol, drugs, or substances that could impair my ability to participate.
• I take full responsibility for consulting with my physician regarding any health concerns related to these services.

Liability Waiver

In consideration for receiving services from I Am Alchemy by Camilla Pellitteri, I hereby waive, release, and discharge any and all claims for damage, injuries, or losses that may arise from my participation.

This includes but is not limited to:

• Physical discomfort
• Allergic or adverse reactions
• Emotional or energetic release
• Unexpected outcomes of herbal, sound, or vibrational therapy

I agree that I am participating voluntarily and fully assume all associated risks.

Client Acknowledgement & Consent

• I confirm that I have read and understood this form in its entirety.
• I have had the opportunity to ask questions.
• I consent to receive services and take full responsibility for my experience.