Yoga, qigong, nutrition and lifestyle modifications can serve as an excellent adjunct to a medical doctor’s treatment but are not a substitute for that treatment. I understand that my practitioner neither diagnoses nor treats disease.
I understand that it is my responsibility as a client to inform my practitioner of all aspects of my health and to inform my practitioner of changes that occur. I will inform my practitioner if I am pregnant and/or suspect pregnancy at any time.
I have read this form and acknowledge that the purposes, goals, potential risks and benefits of the service have been explained to me by my practitioner.
I agree that some of my sessions may be recorded for the purposes of designing my practice and evaluating progress. These recordings will not be shared with anyone else. I agree to photos being taken for the purposes of designing my practice and evaluating progress.
I agree that all materials provided to me, printed or recorded, are for my personal use only. No reproduction or sharing of this material is permitted.
I am free to ask my practitioner questions about any proposed services, the consent form or any other information provided by her. I understand that I am free to discontinue this service at any time. I hereby voluntarily consent to yoga, qigong, nutrition and lifestyle consultation.