RELEASE OF LIABILITY, PROMISE NOT TO SUE, AND ASSUMPTION OF RISK
You must read and agree to the following terms as a condition of receiving services from Dr. Lauren Pichard (the “Practitioner”).
I understand Sacred Soul Health and Alchemy Psychology are the coaching and energy healing aspects of the company Ascension Psychology, Inc. and that I am agreeing to participate in Sessions that are not psychological care.
I understand the Practitioner is a licensed psychologist in the state of California and currently in good standing with the Board of Psychology, but I expressly acknowledge and agree that I am not hiring the Practitioner to engage in the practice of psychology or to provide psychotherapy within the meaning of Section 2903 of the California Business and Professions Code, or to administer psychological or medical treatment for any psychological or medical injury, ailment or disorder within the scope of her license. I am voluntarily hiring the Practitioner for the sole purpose of participating in sessions to learn relaxation techniques, visual imagery, stress reduction, prayers, spiritual understanding, increasing intuition and other shamanic healing, spiritual healing, intuitive readings, mystery school teachings and getting to know ourselves, remove disharmonious energies, restore one’s sovereignty and to connect with our Higher Power. I understand that all Sessions in which I participate are for informational and self -improvement purposes only and are not intended to replace conventional medical or psychological treatment or therapy of any kind.
I understand and agree that (1) any Sessions with the Practitioner do not constitute any form of medical or psychological treatment (including, without limitation: medical evaluations, diagnosis, prescriptions, treatment, or prognosis), and are not substitute for medical or psychological treatment; (2) the Practitioner is not providing medical or psychological treatment during any session; (3) the Practitioner makes no representation or promise regarding the effects or results of an Session or series of Sessions; (4) the Practitioner is not assuming responsibility for the care or treatment of any medical or psychological condition that I had, have, or may have in the future; (5) I will not, based on any Session or Sessions modify, suspend, or discontinue any conventional medical or psychological treatment that I am currently receiving or may receive in the future, without first consulting with my medical or psychological care provider or another licensed medical or psychological care provider; (6) The Practitioner assumes no obligation to to advise me or consult with me about the modification, suspension, or discontinuance of any current or future medical psychological treatment as part of the services rendered in connection with any Session.
Should I decide to pursue licensed psychological treatment for any mental or psychological injury or disorder, regardless of whether I am currently receiving such treatment, I understand that I reserve all rights to seek and to hire any licensed psychologist or other medical service provider, including but not limited to the Practitioner for the provision of such services. I understand and agree that any such services would be independent of and unrelated to any Session with the Practitioner.
I hereby release the Practitioner, on behalf of myself, my next of kin, heirs and representatives and/or any principal for whom I am engaging the Practitioner as an agent, from all liability and promise not to sue the Practitioner for any and all claims, including any claim of negligence of malpractice, based on ineffectiveness of any Session in curing or relieving any psychological or medical injury, or based on any physical or psychological injury, illness, damages, or economic or emotional loss that I may suffer because of my participation in any Session with the Practitioner. I consent to and assume all risks associated with the participation in the self-improvement techniques provided during each Session. I take sole responsibility for alerting the Practitioner if I am uncomfortable at any point during a Session and if I wish to discontinue Session, in whole or in part. I understand the practitioner makes a commitment to helping me to the best of her knowledge heal and attain personal and spiritual growth and that growth is not always linear. I also acknowledge that I may experience discomfort as a part of my journey.
I have read and understand this document and authorize the provision of the services during a Session subject to the limitations in this agreement. I understand that agreeing and executing this release is part of the consideration to the Practitioner for any Session and the Practitioner will not participate in any Session unless I agree to this release and waiver.
As the participant in a Session, I certify that I am at least 18 years of age, of sound mind and competent mental capacity to enter this agreement.
If I am contracting with the Practitioner to provide a Session to a third-party, I certify that I have full authority to enter this agreement and the releases above on behalf of the third-party as their legal guardian, and/or that I have reviewed this agreement with the third-party as their legal guardian and/or that I have reviewed this agreement with the third-party and they have authorized me to release upon a request as a condition to participation in any Session.
No Cancellations and No Refunds Policy
I understand that the Practitioner has invested considerable time, effort and financial commitments in learning her techniques and in making them available for the public. Because of this, all payments made under this agreement are non-refundable and there are no cancellations. I agree to and understand that payment for participation is not dependent upon utilization or satisfaction of services and sessions and I will not, at any time, seek to cancel or receive a refund.
Interruptions of Care
Occasionally treatment is interrupted due to life events such as maternity leave, vacations, or relocating. Unless there is an emergency, at that time and whenever possible, you will be notified of such interruptions.
If at any point Dr. Pichard or any Practitioner assess she/they can not be of benefit to you a discussion around termination will take place. Dr. Pichard and Practitioners do not accept clients who, in her/their opinion, she/they cannot help. You have the right to terminate at any time.
Permission To Record
I understand and consent to the audio and video recording of group sessions. The nature of this is for future group participants to learn from the material and participate in the wisdom and energy of these groups and also for documentation purposes. I also understand and consent to the use of the audio and videos I am in for marketing purposes.
Dr. Pichard does not attend court and legal matters. I understand and agree to not subpoena Dr. Pichard, business affiliates, employees, or anyone involved in Sacred Soul Health, Alchemy Psychology and Ascension Psychology work. However, if for any reason anyone working for the company, including Dr. Pichard is subpoenaed to court for any reason the rate is $2,500 an hour with a court appearance being reimbursed for a minimum of four hours. Other fees for services are agreed upon at time of purchase and payment and based on what is agreed upon.
I have read the above agreement of office policies and general information carefully. I understand them and agree to comply with them.