I, the undersigned, have expressed a desire to meet with a Traditional Healer at the Nottawaseppi Huron Band of the Potawatomi's Health and Human Services Department.
I realize that access to Traditional Healers is being facilitated by the Nottawaseppi Huron Band of the Potawatomi Health and Human Services Department in order to expand the scope of health services offered by the Clinic and to acknowledge the importance of traditional practices.
I understand that it is solely my voluntary choice to seek consultation and potential health services from contact with a Traditional Healer and that I am ultimately in charge of making decisions about health services I may choose to obtain for myself. As with any health service, I understand there is a potential risk associated with any health-related service or medicine and a risk that I may be dissatisfied with the results of any advice or services I may obtain from a Traditional Healer. With this understanding, I accept full responsibility for any risk, injury or liability, or any outcome when consulting with the Traditional Healer. Furthermore, I release and hold the Nottawaseppi Huron Band of the Potawatomi harmless from all liability associated with the care provided or interactions with the Traditional Healer and/or Traditional Healing Program. I certify that I have read and/or understand the contents of this waiver form.