Consent
Form & Medical Waiver
I consent to treatment for myself (or my minor child) and understand that
the services provided by the practitioners employed by BodyTalk Central and
BodyTalkCentral.com are intended to enhance relaxation and increase communication
within my body.
I understand that these services are not a substitute for medical treatment
or medications. I am aware that diagnosis is not given and medication is not
prescribed. I agree to continue to have regular medical check-ups as part
of my overall health care plan.
I understand that participation is voluntary and that at all times I may choose
to end my participation. I understand that I may experience ‘healing
response’ during the 24 to 48 hours following the services provided
and that they will disappear and result in healing.
I understand that any information exchanged during any session is only informational
in nature and is to be used at my own discretion. I also understand that any
information imparted during these sessions is strictly confidential in nature
and will not be shared with anyone without my written permission.
I do agree to give the practitioner consent to use my case history and results
with written permission and without using my name. I understand that the practitioners
at BodyTalk Central and BodyTalkCentral.com will have access to information
in my file to enhance my healing.
I understand that by providing this informed consent I am assuming full responsibility
for my services and I hold harmless both the practitioners, at BodyTalk Cental,
BodyTalkCental.com, and the facility/location where the services are provided.
I understand that there are no guarantees associated with these services,
just as there are no guarantees in other health care modalities.