Policy and Consent:
Your experiences during our sessions are confidential, and you have a right to view your client profile records upon written request. You can send an emailed request to firstname.lastname@example.org or give our team a call at 410-996-4325 for additional help.
Confidentiality is subject to the following exceptions:
• You instruct me to release information to other health care practitioners and/or other individuals, in writing.
• I am subpoenaed or otherwise legally obligated or reasonably allowed to do so (including circumstances where there is clear and imminent danger to yourself or another person).
• Your confidential client profile is kept in a secure location and is retained for 5 years after you end services, after which time all information will be destroyed in a proper manner.
• Your confidentiality is always subject to the usual exclusions dictated by state and federal laws and regulations.
• I have read and understand the above disclosure regarding privacy policies and confidentiality, and that experiences during these sessions are confidential, but subject to the usual exceptions governed by laws of the State of Maryland and other federal laws and regulations. *
Scope of Care & Client Consent to Be Supported
Tanisha Johnson provides personal empowerment services and womb healing sessions to support natural, non-invasive, and non-toxic healing experiences and coaching. I understand that Tanisha Johnson is not a licensed physician or coach, as her scope of care, at present, is unregulated and therefore, her services are not licensed by the state of Maryland.
I understand it is my responsibility to maintain a relationship for myself with a medical doctor, mental health professional, or any other essential specialized health professional, if I so desire. I further understand that Tanisha Johnson is not trained to diagnose illness, make recommendations involving pharmaceutical drugs or surgery, or handle medical emergencies. I also understand that the statements and services offered have not been evaluated by the US Food and Drug Administration.
I hereby release, waive, acquit and forever discharge Sacral Lotus Wellness Sanctuary and Tanisha Johnson, any agents, successors, assigns, personal representatives, executors, heirs and employees from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of acts or omissions by myself or by Tanisha Johnson, as a result of the recommendations given or otherwise resulting from any booked sessions.
I further declare and represent that no promise, inducement or agreement not expressed in this agreement has been made to me to sign this agreement. This agreement shall bind my heirs, executors, personal representatives, successors, assigns, and agents.
Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Sacral Lotus Wellness Sanctuary and Tanisha Johnson, from and against any and all claims or liability of whatsoever kind or nature arising, out of or in connection with, my session(s).