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Contract For Somatic Healing

Disclosure and Disclaimer Regarding Services People with Epilepsy or any person diagnosed as having a psychotic illness should not enter hypnosis or EMDR. Please do not apply if you have any of these illnesses or be sure to clearly inform Kelli Leis. Kelli Leis accepts no responsibility whatsoever. Under no circumstances including but not limited to negligence shall Kelli Leis be liable for any special or consequential damages in any way whatsoever now or in the future that result from the use of or the inability to use hypnosis, advanced hypnotic techniques, hypnotherapy, EMDR or any other therapies. The information, techniques, methods, and recommendations by Kelli Leis are not intended to substitute for the diagnosis and the care of a qualified doctor nor to encourage the treatment of illness by persons not recognizably qualified. If you use hypnosis or EMDR and are under medical care for any condition, do not make any adjustments to any prescribed medication without the approval of your doctor. If you are in any doubt, you should seek medical advice. Kelli Leis has taken due care and attention with the information provided at this session and information is given in good faith. The information given is not intended to constitute medical advice. Always consult your GP before changing medications and evaluating treatment alternatives. Kelli Leis does not accept responsibility for any loss, damage or expense resulting from the use of the information provided.

You agree to indemnify and hold us harmless by signing and agreeing to these conditions. By my signature below, as the “Client” (and if applicable “Guardian”), I represent that I have read and understood and agree to the following:

Kelli Leis is a NEITHER TRAINED MENTAL HEALTH PROVIDERS NOR MEDICAL PRACTITIONERS. THE SERVICES ARE NOT INTENDED TO REPLACE MEDICAL TREATMENT. The provider does not offer the services or treatment of a licensed physician, clinical psychologist, or psychiatrist. Provider is not licensed to practice psychology, and Provider does not claim to offer any psychological benefits, or psychometrist (or any form of psychometrics) or psychometry services. The provider disclaims all statements, representations, warranties, agreements or promises regarding the use or benefits of the Services, whether made by the Provider, its clients, employees, agents, or contractors. Participating in the Services does not guarantee success, and the Provider makes no representation or guarantee through Client’s participation in the Services. All information on the Provider website or included in statements, testimonials or materials made or distributed by or on behalf of Provider are for informational purposes only and are not intended to be relied on by Client or to constitute a representation of the effects or benefits of the Services. Assumption of Risk, Release of Liability, and Agreement to Arbitrate PLEASE READ THE FOLLOWING CAREFULLY.

BY SIGNING BELOW, YOU ARE GIVING UP CERTAIN LEGAL RIGHTS. By my signature below, as the “Client” (and if applicable “Guardian”), I further represent that I have read and understood and agree to the following:

I freely and voluntarily choose to participate in the Services provided by Provider. My participation may include unknown negative reactions. I accept all risks for any adverse reactions that I may have. I understand that participants with certain health conditions such as epilepsy and psychosis are not recommended to participate in the Services. I represent to the Provider that I have no such health conditions that would prevent me from safely participating in the Services.

I HEREBY ASSUME ALL SUCH RISKS associated with the Services, know or unknown, including without limitation injury, illness, death, and/or other adverse reactions. I am aware of such risks associated with the Services, including my own physical condition and the actions or conduct of others that I may come into contact with after participating in the Services.

I understand that by participating in the Services, I may experience emotional personal memories. ASSUMING ALL SUCH RISKS, I HEREBY RELEASE, WAIVE ANY AND ALL CLAIMS AGAINST, WILL NOT SUE AND WILL HOLD HARMLESS, Provider from all actions, omissions, causes of action, suits, debts, damages, losses, judgments, injuries, liabilities, and claims and demands whatsoever, in law or in equity (collectively, “Claims”), including without limitation personal injury and death, emotional distress, indirect damages, consequential damages or exemplary damages, even though such Claims may be caused by or result from the negligence or carelessness of such released parties.

I agree that this waiver and release binds me and my heirs, distributives, guardians, legal representatives, successors and assigns.

Further, I agree to indemnify, protect, defend and hold harmless Provider, its owners, members, managers, officers, employees, agents and representatives, from and against all Claims arising from or in connection to my involvement or participation in the Services offered by Provider. I understand that I will be on time and punctual with my sessions and that should I need to postpone a session with less than 72 hours’ notice, Kelli Leis can move onto your next session having missed the said, booked session.

If a session is missed by cancellation of the client, it is the client’s responsibility to reschedule with Kelli Leis, Once payment has been made, there are no refunds and signing this contract means acceptance that these services are with a no refund policy.

Signing this contract waives right to refund within 14 days of payment as Kelli Leis has to research, plan and prepare for each session with each individual client, outside of the hours of service and client session.

This includes if part payment has been made, the client is still liable for remainder of payments as services are provided that the client may email Kelli Leis between the hours of 9am-5pm EST. Monday to Friday and that provider will respond in a timely manner. Kelli Leis reserves the right to end the client relationship at any time if reason has arisen to do so with a refund of any further sessions given excluding existing services received.

By my signature below, as the “Client” (or if applicable “Guardian”), I accept the foregoing disclosure, disclaimer, assumption of risk and waiver, and I represent and warrant for Provider’s reliance, and agree, as material consideration without which Provider would not provide the Services, that:

  2. All of my questions have been answered to my full satisfaction.
  3. I am not relying on any statement, representation or warranty, agreement or promise by or on behalf of the Provider that is not expressly set forth in writing signed by Provider.
  4. I am aware that this is an assumption of risk, release of liability and agreement to arbitrate and that I am giving up legal rights; and
  5. I sign below of my own free will IF CLIENT IS UNDER 18, THE PARENT (OR GUARDIAN, IF ANY) MUST SIGN BELOW:

 I am the parent or legal guardian of the above Client and he/ she has my permission to participate in the Services with Provider. I have read and agree to the provisions stated above for myself and Client.

I agree to indemnify, protect, defend, and hold harmless Provider, its owners, members, managers, officers, employees, agents and representatives, of all liabilities, claims, losses, damage or injury to person or property which may occur or be incident to Client’s involvement or participation in the Services offered by Provider. Sessions are non-refundable once paid. All sessions are 100% private and confidential unless Kelli Leis feels the client is in danger or has disclosed illegal activity.