Please read the following information carefully before beginning any alternative wellness or nutritional support program. Your signature indicates your understanding and agreement to the terms outlined below.
PRACTICE PURPOSE
The purpose of this program is to support individuals in improving their overall well-being through nutrition education, lifestyle guidance, and the non-medical use of dietary supplements. The services provided are educational and supportive in nature, aiming to enhance the body’s natural ability to self-regulate and restore balance.
These services are not intended to diagnose, treat, cure, or prevent any disease or medical condition. The practitioner does not operate as a licensed physician, dietitian, naturopathic doctor, or medical professional. Any recommendations made are not to be interpreted as medical advice or a substitute for licensed healthcare.
SCOPE OF SERVICES
By participating in this program, you acknowledge and agree that:
The practitioner, Angelina Gradskaya, is not a licensed physician, psychologist, dietitian, or any other licensed healthcare provider.
No diagnoses will be made, nor will prescription medication be recommended or altered.
You are encouraged to consult your licensed medical provider before making any changes to your diet, lifestyle, or supplement regimen.
DISCLOSURE & RESPONSIBILITIES
You may be asked to share personal details related to your health history, habits, energy levels, and dietary practices. This information helps your practitioner assess your current state, provide education, and offer personalized recommendations. This information will be kept confidential unless required by law or with your explicit written consent.
If signs or symptoms of a disease or condition arise during your sessions, you may be informed of such observations. However, these are not to be interpreted as diagnoses. You are encouraged to seek medical attention from a licensed provider for all health concerns.
If you are working with the practitioner regarding a known disease or condition, it is your responsibility to disclose this information fully and to inform all of your licensed care providers of any changes made as a result of this program. You should never alter or discontinue any prescribed treatments without first consulting your prescribing provider.
The practitioner is relying on the accuracy and completeness of the information you provide. Any actions you take based on recommendations made are entirely your responsibility.
ASSUMPTION OF RISK & RELEASE OF LIABILITY
By signing this agreement:
You agree to voluntarily participate in wellness services provided by Wellness Awakening With Angelina.
You accept full responsibility for your own health decisions and outcomes.
You release Angelina Gradskaya and Wellness Awakening With Angelina, as well as any representatives, heirs, or assigns, from any and all claims, liabilities, damages, or costs arising from your participation in the program, including but not limited to any illness, injury, or death, whether caused by negligence or otherwise.
APPOINTMENT POLICY
A minimum of 3 hours' notice is required for all cancellations. Late cancellations (within 3 hours of your scheduled appointment) will be billed at 75% of the session rate.
CLIENT UNDERSTANDING
I understand that any wellness services I undertake at Wellness Awakening With Angelina are entirely voluntary. I acknowledge that the ultimate responsibility for my health lies with me. I hereby agree to assume full responsibility for any manner of loss, injury, claim, or damage whatsoever, known or unknown, incurred as a result of my participation. I, my heirs, executors, administrators, or assigns hereby release all rights to bring claims in connection with my participation in this program.
I HAVE CAREFULLY READ THIS AGREEMENT AND AGREE TO THE TERMS OUTLINED ABOVE. I UNDERSTAND THIS DOCUMENT TO BE A FULL AND FINAL RELEASE OF ALL CLAIMS ARISING FROM OR IN CONNECTION WITH THE SERVICES PROVIDED.