HAMC Waiver (Online) The following Release and Liability Waiver is effective for all visits.Untitled By signing below, I acknowledge and agree that: Practitioners at Healing Arts Metaphysical Center do not diagnose conditions, prescribe medications or provide medical treatments The sole purpose of this session/s is for relaxation or stress reduction. Additionally, to balance, harmonize, release and heal on all four levels (physical, mental, emotional and spiritual) I understand that some bodily functions may temporarily be affected as a result of shifting energy within my body and I agree that this is a natural occurrence (E.g. release of gas from the rectum) or is nonsexual in nature (E.g. erection in male clients) I assume sole responsibility for my own health and for the results of any sessions provided by Healing Arts Metaphysical Center that may affect my health in any way Session/s will not replace conventional medical diagnosis or treatment. I will continue taking medication prescribed by a licensed medical physician and will continue to follow his/her instructions I release Healing Arts Metaphysical Center, its owners and practitioners from all legal liability during my participation in Healing Arts Metaphysical Center session/s All information received by me from Healing Arts Metaphysical Center’s practitioners is accepted with full knowledge that any action taken by me as a result of the information received is my complete responsibility Signature(Required)Date(Required) DD slash MM slash YYYY Please Print Name(Required) Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone(Required)Email(Required) Recommended/Referred by Would you like to be added to our mailing list? Yes No Healing Arts Metaphysical Center We strive to provide the best attention to all our clients. To be consistent with this, we have Late and Cancellation Policies in place. Late Policy As a courtesy, we send text and email to confirm your appointment wone day prior to your appointment date and one hour prior to your appointment time. However, if we are unable to reach you please understand that it is your responsibility to remember your appointment dates and times to avoid late arrivals, missed appointments and a no-show fee. We understand that sometimes being late is unavoidable. However, depending on circumstances, we may be forced to shorten your service. Clients who arrive late will be charged in full for their scheduled session but will receive an abbreviated session. For example, if you scheduled an hour session and arrive 15 minutes late, you will be charged for that hour session but will only receive 45 minutes of treatment for that session. Cancellation Policy Your appointments are very important to us. Your appointment time has been set aside just for you and when it is missed, that time cannot be used for anyone else. If you must cancel or reschedule an appointment please provide us with at least a 24-hour notice. We understand that unavoidable issues come and we will do our best to work with you in case you need to reschedule your appointment. If you miss an appointment without contacting our office, we reserve the right to charge a missed appointment fee of $50.00. We appreciate your patronage and compliance with our policies.Consent I have read and agree to the Late and Cancellation Policies.SignatureDate MM slash DD slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ
