This form contains information to help you make informed decisions about wellness services with Family of Choice LLC.
This Wellness Services Client Agreement / Contract (hereafter referred to as "The Agreement") constitutes a contract between Family of Choice LLC (hereafter referred to individually as the "Provider") and the Undersigned, yourself as indicated on the signature page (hereafter referred to as the "Client"). AS THE CLIENT, YOU SHOULD READ IT CAREFULLY AND RAISE ANY QUESTIONS AND/OR CONCERNS PRIOR TO SIGNING THIS AGREEMENT. Family of Choice LLC offers multiple programs to include Reiki, Sound Healing, Coaching and Prevention Services. Services range in times and cost as listed below:
Sound Healing:
Sound healing is an ancient practice that harnesses sound vibrations to promote healing, relaxation and self-care. This service involves lying down in a comfortable position, closing our eyes, and focusing on sounds made by musical instruments such as singing bowls, chimes and gongs. The sound vibrations can have a powerful effect on our bodies and minds. Research shows that sound waves can slow our brain waves and can result in a dream-like state. It may be utilized as a relaxation state adjunct to other mental and physical health treatments. This can be provided for individuals, couples or in small groups. Please select your service when scheduling.
Scope of Engagement:
The Client chooses and agrees to participate fully in the Wellness Services selected below. The provider is here to help, guide, advise and support the Client as well as to review any work that is completed during the program. The Client acknowledges that the Program is designed to transform and help Clients grow as a person and in their business. In order to grow, people often need to face the possibility of unpleasant things and be pushed out of their comfort zone, and the Client agrees to be open to such experiences throughout the course of the transformation. The provider may terminate or change the terms of this Agreement at any time in its discretion upon notice to the Client if they feel that the professional relationship is not respectful. The Client understands that any failure on their part to complete the action steps in full throughout the program will result in possibly not receiving the full benefit of the program. All practitioners are certified to provide the service. You may request details on their certification and training at any time.
Payment & Billing:
I UNDERSTAND AND AGREE TO THE FOLLOWING: Your bill is due at the time of service. Sound healing and Reiki services are non-refundable. If for some reason I have created a balance on my account, further services will not be provided until the balance is paid in full.
Cancellation Fees:
The Term of this Agreement will commence upon YOUR acceptance of this Agreement. You further acknowledge that in accepting the terms of this Agreement and affirmatively seeking the benefits YOU are taking full responsibility for YOUR OWN success.
Limits to confidentiality:
All information from sessions is confidential with some exceptions because of our provider's other qualifications as qualified or licensed mental health professionals. Exceptions to confidentiality are (a) When information pertains to child or elder abuse or neglect, (b) When a client brings charges against the practitioner, (c) When the practitioner is called upon to testify in court or hearings about adoption, adult abuse, child abuse, child neglect or other matters pertaining to the client’s welfare, (c) When the practitioner needs to prevent a clear and immediate danger to a person or persons (suicide or homicide).
I understand any information my practitioner receives and relates to me during a Wellness Session may be literal or symbolic and that I am solely responsible for the decisions and choices I make towards healing. I understand that the services provided are completely separate from my provider's other roles as a qualified or licensed mental health professional. Wellness Services are NOT considered Therapy.
Medical Concerns:
I will notify the provider of any medical concerns that I have. It is my responsibility to inform the provider and refrain from participation if I feel uncomfortable at any time. The provider does not assume liability for my physical wellbeing. I will notify the provider if I am pregnant.
My signature below indicates that I understand and agree with the practitioner’s policies and give informed consent to receive Wellness Services from Family of Choice LLC. Parents must sign for their minor children. Each participant must complete their own consent form.