Holistic Goddess Collective Consult Waiver

Assumption of Risk and Release of Liability

I hereby acknowledge and agree:

The purpose of working with Bianca Williamson and Holistic Goddess Collective is to improve the overall health, vitality and well-being of the body through homeopathic treatment, diet and lifestyle changes.

Holistic Goddess Collective do not diagnose disease, disorders or medical conditions. Holistic Goddess Collective and its Practitioners are not licensed medical physician/s and nothing they say is medical advice.

As part of these services, I may be asked to provide information concerning my physical habits, medical history, moods, energy levels, likes and dislikes, lifestyle and diet. This information is confidential, unless the patient poses a risk of harm to themselves or others.

In providing homeopathic treatment to me, Holistic Goddess Collective is relying upon the truth, accuracy and completeness of all information I have provided. Any recommendations I follow for changes in homeopathic treatment, diet, including the use of nutritional supplements, are entirely my responsibility.

I understand that homeopathic medicine, whilst natural and holistic medicine, can cause side effects in the way of symptoms. I understand that these can be uncomfortable, including physical, mental and emotion distress, and I will use discernment to get medical treatment or necessary psychotherapy if necessary. The team at Holistic Goddess Collective is in no way liable for my health or safety.

In consideration of my participation in working with Bianca Williamson, Holistic Goddess Collective and it’s Practitioner/s, I hereby accept all risk to my health, including injury or death that may result from such participation and I hereby release Bianca Williamson and Holistic Goddess Collective, on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, including my death, that may result from or occur as a result of my participation in treatment at Holistic Goddess Collective, whether caused by negligence or otherwise.

I understand that any therapies I undertake at Holistic Goddess Collective are undertaken of my own free will. I accept that the ultimate responsibility for my health care is my own and Holistic Goddess Collective and it’s Practitioner/s are here to support me in this. I understand that my Practitioner reserves the right to determine which cases fall outside their scope of practice, in which event an appropriate referral will be recommended.

I hereby agree to assume full responsibility for any manner of loss, injury, claim or damage whatsoever, known or unknown, incurred as a result of treatment and I, my heirs, executors, administrators or assigns for any loss, injury, claim or damage sustained as a result of my attendance and/or participation.

I have read the above release and waiver of liability, and fully understand its contents and voluntarily agree to the terms and conditions stated.

Full Name/s: 

Date:

Signature/s:

 

Holistic Goddess Collective

bianca@holisticgoddess.com.au