CONSENT FORM
I understand that Andrea A. Zwegat is offering her services as an ordained minister and personal coach, and that she is not a licensed physician or health professional.
I further understand that a medical intuitive reading is an intuitive method of gaining further information from my physical body and that it is not a medical treatment, a diagnosis, or a prescription for treatment--natural or medically prescribed. I understand that this is not a substitute for medical, mental, holistic or any other professional advice or expertise.
Energy healing sessions may have to date yielded remarkable results for balance and well-being. While there have been no distressing side effects reported to Andrea’s knowledge, this does not mean that I will not discover side effects for myself. I further understand that any energy healing sessions such as but not limited to Reiki, Reconnective Healing, Emotional Freedom Technique, or any other healing modality offered by Andrea, make no representations, warranties, or guarantees of healing. I understand that the energy healing sessions are not a medical treatment, a cure, a diagnosis, or a prescription for treatment--natural or medically prescribed. I understand that this is not a substitute for medical, mental, holistic or any other professional advice or expertise.
I agree that I am responsible for my interpretation, decisions and actions regarding my mental and physical health as well as my personal life based on the information provided in my medical intuitive reading and/or my experience with energy healing. It is hereby agreed that Andrea A. Zwegat will not be held liable in contract or in tort for any personal injury of any nature whatsoever that arises from or is the result of a medical intuitive reading and/or energy healing.
I am 18 years or older and have read and understand this notice and its contents.
Signed this _______ day of __________, 20____
Signature ______________________________________
Name: _________________________________________________________
Address: _______________________________________________________
Phone: __________________ email: _______________________________
Return with fee to:
Andrea A. Zwegat
36003 Kilarney Road
Willoughby, Ohio 44094
© 2003 Andrea A. Zwegat d/b/a/ Intuitive Energetic Solutions