My decision to receive services from the Soul Serenity and Divine Wellness Retreat, Holistic Healing 4 U, LLC is a voluntary and personal decision. I understand that the services and practices are not a substitute for treatments, services or consultations ordinarily provided by medical doctors or other health care professionals for physiological or psychological complaints but can be used in conjuction. Consulting a healthcare provider of choice to participate in the services and activities is recommended especially indiviuals with a history of abuse or trauma. I agree to participate in the activities only within the range of my ability and physical comfort. I have not been made any promises or warranties that I will receive any specific results. I acknowledge that I take complete responsibility for my own physical, emotional and mental health and wellbeing both during and after my participation in the services and activities offered. I understand that some ativities, techniques/practices should not be practiced while driving a vehicle, operating machinery or while involved in activities requiring my full attention. I agree any instructions given to me are personal and may not be appropriate instructions for others. I hereby waive and discharge any claim against, Beth Stoller, LMT, Holistic Healing 4 U, LLC, or any of its respective associates on the premises at The Banyan House, and any heirs for any and every injury, damage or loss of any kind whatsoever arising from my participation in and use of the services, approaches, techniques, practices and use of the facility at The Banyan House. CANCELLATION POLICY: Clients are responsible for payment, both for services when rendered and for missed appointments if they fail to give 24 hours advance notice of cancellation.
To the best of my knowledge, I hereby state the information in this form is true and correct.
Client Signature:____________________________________________
Date:________________________________
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