I understand that Bliss Wildwood offers holistic therapies and non-traditional complementary interventions in the form of various modalities of energy healing (including but not limited to reiki, crystal, and chakra); all of which are intended to promote health and wellness.

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I understand that my practitioner is a trained Wellness Practitioner, and is not a massage therapist, chiropractic doctor, registered nurse, registered dietitian, nor a medical doctor. I understand, the practitioner is not qualified to diagnose, treat, cure, prevent or assess any disease, disorder or condition. I understand, the practitioner is not qualified to prescribe medication or dietary alternatives.

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I understand that holistic therapy interventions are not a substitute for medical treatment or medications, and that it is recommended that I concurrently work with my primary healthcare provider for any condition I may have.

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I am aware that the practitioner does not diagnose illness or disease, does not prescribe medications, and that spinal manipulations are not part of holistic therapy.

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I understand that following any set regime does not promise any form or level of cure for any specific (or otherwise) condition. I promise to abide by any warnings or contra-indications given to me through consultation if products and services are used. I understand that I am under no obligation to follow any recommendations for treatment given.

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I have informed the practitioner of all my known physical and medical conditions, and I will keep the practitioner updated of any changes. I will notify the practitioner should I become pregnant of if I am trying to become pregnant.

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I understand the practitioner and administrative staff may review my medical records and reports, but all of my records will be kept confidential and will not be released without my written consent. I have read and understand this consent to treatment. I have been informed about the risks and benefits of holistic therapy procedures.

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I intend this consent form to cover the entire course of treatment for my present condition and for any future conditions for which I seek treatment.

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I release Bliss Wildwood from all legal liability during my participation in the energy healing treatments. All information received by me from Bliss Wildwood is accepted with full knowledge that any action taken by me as a result of the information received is my complete responsibility.

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Having read, completed and understood the foregoing, I request to receive holistic energy healing treatment. I understand that my practitioner is providing a holistic energy healing treatment for me at my request, and is not responsible for the outcome of the energy healing session. I agree to hold Bliss Wildwood harmless for any intended or unintended result.

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Nature of Energy Healing Treatments

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I understand and believe that self-improvement requires commitment on my part, and that I must be willing to change in a positive way if I am to receive the full benefit of a holistic energy healing treatment. I acknowledge my commitment to my self-improvement process. I recognize that an energy healing treatment program must be followed to be truly effective, just as prescribed medication is only effective if taken as directed.

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I acknowledge that the practitioner neither claims nor implies that any instruction, advice, counsel, suggestions, recommendations, services or products she or her representatives provide, whether in person, by mail, by telephone, or by internet, will cure, treat, prevent, or mitigate any disease condition; but are provided solely for the purpose of increasing energy, supporting the natural function of body systems and otherwise improving general health and fitness.

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