Women should not v-steam, if they are experiencing:
open wounds, sores, or blisters (men and women)
pregnancy or think you may be pregnant
If you have a genital piercing(s), please remove prior to steaming, due to the risk of genital burning.
I have carefully read and reviewed this acknowledgment and waiver of liability, and I fully understand all of its terms and conditions. I recognize and accept all risks and limitations involved in seeking advice and treatment therapies from New Leaf Wellness Center, its associates, employees, agents and representatives thereof. I have not relied upon any other promises, agreements or representations by body in motion, or any associates, employees, agents or representatives thereof concerning the treatment provided or the terms of this acknowledgment and waiver of liability. I have been encouraged by New Leaf Wellness Center to seek the advice of legal counsel concerning this acknowledgement and waiver of liability, and I execute and deliver this acknowledgement and waiver of liability freely and voluntarily and without duress or coercion and with full knowledge of the representations contained herein and the rights relinquished, surrendered, released and discharged hereunder. Understood, accepted and agreed.
I understand that payment is due in full at the time of service of an appointment for treatment at New Leaf Wellness Center. I agree to give at least 24-hour notice of cancellation of appointment otherwise I will lose my paid treatment fee in full and be required to pay again for any new appointment. I understand the treatment here is not a replacement for medical care. I understand the therapist/practitioner does not diagnose medical illness, disease or any other physical or mental conditions (unless specified under his/her professional scope of practice) as such, the therapist/practitioner does not prescribe medical treatment of pharmaceuticals. I understand that the treatment is not a substitute for medical treatments and/or diagnosis and it is recommended that I see a qualified professional for any physical or mental conditions that I may have. I have stated all my known conditions and take it upon myself to keep the therapist/practitioner updated on my health.
I give my permission for my therapist/practitioner to take notes about me, including health history, medical, and/or personal information I choose to disclose to him/her. I also understand that this information will anonymously be used for the New Leaf Wellness Center, LLC. For statistical purposes, and that my practitioner may use this information to provide me with a summary for my own personal use.
I have read this release form and confirm that all the information I have given on this document and the customer health history form is correct and to follow the general care instructions. I understand that this is a release form and I agree to be legally bound by it.