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Non Traditional Holistic Healing
Consent Form
I hereby give my consent to participate in this in person, 1-on-1 Private Ceremonial Session and understand that the services provided by my chosen Sacred Plant Medicine Practitioner are intended to provide health benefits of boosting your wellness & reduce stress. I understand completely that the services provided during this Holistic Healing Treatment are in no way a substitute for traditional medical treatment or advice. I am fully aware that my chosen Sacred Plant Medicine Practitioner will not offer any diagnosis or recommend any Medical Treatment or Prescribed Medication. I understand that I must continue to have regular medical check-ups as part of my overall personal health care plan; and I should contact my own certified and licensed medical physician/doctor/health care professional for any physical or psychological ailments or concerns that I may have in order to get proper medical advice. I agree and understand that my participation in this Holistic Healing Treatment is voluntary and that at any time during the Treatment I can choose to end my participation. I also understand that I may experience 'self-release & renew responses' during the 48 hours following the Ceremonial Session. I understand that any information exchanged during any session is educational in nature and is to be used at my own discretion. I also understand that any information imparted during these sessions is strictly confidential and will not be shared with anyone without my written permission. Finally, I understand that by providing this informed consent I am assuming full responsibility for participating in this Holistic Healing Treatment & Ceremonial Session and I hold harmless both my chosen Sacred Plant Medicine Practitioner and the facility/location where the services are provided. I agree to the terms and conditions set out by this In Person, 1-on-1 Private Ceremonial Session and Holistic Healing Treatment Consent Form and certify that the above information is true and correct. I have read and agree to the terms above.
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