Notice to Clients

Under California Senate Bill 577, I am required to provide you with the following information:

• I am not a licensed physician, psychologist, or other licensed health care provider in the State of California.
• I do not diagnose, treat, cure, or prevent any medical or psychological condition.
• The services I provide are complementary and alternative wellness services.
• These services are not a substitute for licensed medical, psychological, or psychiatric care.

 

DESCRIPTION OF SERVICES

I provide holistic and energy-based wellness services, which may include (but are not limited to):

• Energy healing 
• Reiki or other biofield therapies
• Chakra balancing
• Intuitive guidance
• Meditation facilitation
• Breathwork
• Sound healing
• Spiritual or wellness coaching
• Stress-reduction techniques and bodywork

​

​

Services are offered in person and/or remotely (online/distance sessions). These services are intended to support relaxation, stress reduction, self-awareness, and overall well-being.

 

NO MEDICAL OR MENTAL HEALTH ADVICE

I do not:

• Diagnose health conditions
• Provide medical or psychological treatment
• Prescribe medications or supplements
• Recommend discontinuing treatment prescribed by a licensed provider
• Interfere with medical or mental health care plans

​

You understand that it is your responsibility to seek medical or mental health care from a licensed provider for any physical or psychological condition. You agree to consult a qualified healthcare provider before making any health-related decisions.

 

ONLINE / DISTANCE SESSION DISCLOSURE

For virtual sessions conducted by phone or video platform (e.g., Zoom or similar services), you understand and acknowledge:

• Technology may fail, be interrupted, or experience delays.
• Electronic communications may not be completely secure despite reasonable safeguards.
• You are responsible for ensuring you are in a safe, private location during the session.
• You are responsible for having adequate internet connection and device capability.

You agree that online sessions are not appropriate for medical or psychological emergencies.

If you are experiencing a medical or mental health emergency, you agree to call 911 or seek immediate assistance from a licensed healthcare provider.

​

VOLUNTARY PARTICIPATION

You understand that:

• Participation in sessions is voluntary.
• You may decline any technique or stop a session at any time.
• Results vary from person to person.
• No guarantees have been made regarding specific outcomes.

 

ASSUMPTION OF RISK

You understand that complementary wellness services involve subjective experiences and individual responses. You voluntarily assume full responsibility for your participation in both in-person and online sessions.

You agree to inform the practitioner of any relevant medical, psychological, or physical conditions prior to your session.

 

WAIVER OF LIABILITY

To the fullest extent permitted under California law, you agree to release and hold harmless the practitioner and business from any and all liability, claims, demands, damages, or expenses arising out of or related to your participation in holistic or energy-based services, whether provided in person or online, except in cases of gross negligence or willful misconduct.

 

CONFIDENTIALITY

All personal information shared during sessions will be kept confidential, except:

• When disclosure is required by law
• If there is risk of harm to yourself or others
• In cases of suspected abuse or neglect as required by mandatory reporting laws

 

DONATIONS & CANCELLATION POLICY

Donations must be made prior to beginning of your session. Failure to do so can result in cancellation of your appointment.

Cancellation Policy: Cancellations may occur up to 1 hour before the appointment time and rescheduled with no additional cost

​

ACKNOWLEDGMENT AND CONSENT

By signing below, you acknowledge that:

• You have read and understand this disclosure and waiver.
• You have had the opportunity to ask questions.
• You understand that the practitioner is not a licensed healthcare provider.
• You voluntarily consent to receive holistic and energy-based wellness services in person and/or online.

​

Client Signature: _________________________________________
Date: ___________________

Printed Name: ____________________________________________

Practitioner Signature: ____________________________________
Date: ___________________

Copy provided to client on: ________________________________