New Client Informed Consent
* The following form is for confirmed clients only. If we haven't set up an appointment yet, please reach out at 805-390-8387 or email@example.com
The goal of all sessions with Andreea G. Petruse is to create within the body and mind an optimum environment for healing to take place and to maximize the body’s ability to heal itself using the principles of QSL, along with other holistic methods.
Andreea G. Petruse is not trained in Western medical diagnosis or treatments; although adept in somatic therapy, she is not a physician, nor licensed health care professional. No medical advice, diagnosis or medical treatment is given during the sessions.
If you are suffering from a disease or severe symptom that has not been evaluated by a medical doctor or another licensed health-care professional, you must be evaluated by a medical doctor. If I choose not to see a medical doctor, by signing this I acknowledge that consultation with a medical doctor has been recommended to me.
I understand that this and any subsequent sessions, along with any assessment or information ensuing thereafter is for general educational purposes only and that no claim to medical diagnosis or medical treatment, or the cure of any medical condition, is inferred or implied. I further understand that this session and any recommendations ensuing thereafter should not be construed as a substitute for medical examination diagnosis and treatment, and that I should see a medical doctor or other licensed primary health care provider for any physical or mental ailment or complaint that I may have. I understand that this session may include assessment of psychophysiological conditions and occasional related suggestions for dietary, herbal or other lifestyle regimens and that these are given from a QSL and herbal medicine perspective only. I understand that any suggestions or recommendations are in no fashion intended as a prescription for any condition. I understand that Andreea G. Petruse is not qualified or licensed to diagnose, prescribe for or treat any physical or mental illness, and that nothing said in the course of any consultation or session should be construed as such. I understand that any healing process requires my active participation and is my own personal responsibility.
I also understand that during this and subsequent sessions, all attempts to maintain full confidentiality will be made with the exception of the following situations: child and elder abuse, medical emergencies, imminent threats or dangers to self or others.
I fully understand and acknowledge that I will be examining both physical and mental states during my session, whether in person or online. I certify that my physical, mental and emotional condition will allow me to safely participate in all aspects of the session and any subsequent sessions with Andreea G. Petruse . I fully agree to assume all responsibility for any risks, injuries, damages, accidents or events, known or unknown, which I might incur as a result of participating in this and any subsequent sessions with Andreea G. Petruse.
I also acknowledge that if I must cancel an in person session I must give notice at least 24 hours in advance, and that if I fail to do so, I am responsible for the partial session cost of $ 50.
I have read, reviewed, and considered the above waiver and release. I fully understand its contents, and by signing it freely, I agree to all terms. I am legally competent to voluntarily agree to the terms and conditions of the waiver and release and it is my express intention to exempt and relieve Andreea G. Petruse from all liability.
By signing this, I agree to and understand all of the above information in this virtual waiver.
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