Coaching & Healing Session Waiver

Name *
Address *
Emergency Contact *
Emergency Contact
All wellness and coaching services and communication, email or otherwise, delivered by your practitioner, (your “Coach”),  are meant to help you identify the areas in your life and in your thinking that may be standing in your way. However, coaching/healing work is not professional mental health care or medical care. If you feel psychologically stressed to the point that it is interfering with your ability to function, please have the courage to seek the help you need in the form of a professional counselor. Coaching/Healing may augment your therapy, but the work of coaching/healing is meant to be done when major emotional and psychological wounds are already healing or healed. *
In that spirit, by purchasing services from your practitioners, you confirm that you have read and agree to each statement and that you wish to proceed: I understand that the services I will be receiving are not offered as a substitute for professional mental health care or medical care and are not intended to diagnose, treat or cure any mental health or medical conditions. I also understand that my Coach/Healer is not acting as a mental health counselor or a medical professional. I understand that coaching/Healing is, at present, an unregulated industry and that my Coach/Healer may not be licensed. I understand and agree that I am fully responsible for my well-being during my sessions, and subsequently, including my choices and decisions. I understand that my sessions are not a substitute for counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment, and I will not use it in place of any form of therapy. I understand that all comments and ideas offered by my Coach/Healer are solely for the purpose of aiding me in achieving my defined goals. I have the ability to give my informed consent, and hereby give such consent to assist me in achieving such goals. I understand that to the extent our work together involves career or business, my Coach/Healer is not promising outcomes included but not limited to increased clientelle, profitability and or business success. I understand that my Coach/Healer will protect my information as confidential unless I state otherwise in writing. If I report child, elder abuse or neglect or threaten to harm myself or someone else, I understand that necessary actions will be taken and my confidentiality agreement limited in this capacity. Furthermore, if my Coach/Healer is ordered by a court to provide information or to testify, she will do so to the extent the law requires. I understand that the use of technology is not always secure and I accept the risks of confidentiality in the use of email, text, phone, Skype and other technology. I hereby release, waive, acquit and forever discharge my Coach, Healer, Amour Soul Space, any agents, successors, assigns, personal representatives, executors, heirs and employees from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of acts or omissions by myself or by my Coach/Healer as a result of the advice given by my Coach/Healer or otherwise resulting from the relationship contemplated by this agreement. I further declare and represent that no promise, inducement or agreement not expressed in this agreement has been made to me to sign this agreement. This agreement shall bind my heirs, executors, personal representatives, successors, assigns, and agents.
Date Signed *
Date Signed
Digital Signature *
By checking the "Agree" box below I am digitally and legally signing my name to this agreement

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