Session consent and health information form

Introduction

Please read this form carefully. Your session cannot go ahead until you have signed it. If anything is unclear, ask your practitioner before signing.

1. About the session

Practitioner: [practitioner name], an independent practitioner.

Type of session: [for example, bioenergetic balancing, in person or remote].

Bioenergetic sessions are complementary wellbeing practices. They are not medical care. The practitioner does not diagnose, treat, cure or prevent any disease, and does not prescribe or advise on medication. Unless stated otherwise, the practitioner is not a licensed medical provider.

2. Your health and medical care

I understand this session is not a substitute for medical care, and I will continue to follow the advice of my doctor or other licensed healthcare providers.

I will not stop, change or delay any medical treatment or medication because of this session.

I understand that if I have a medical emergency I should call 911 or my local emergency number.

3. Everything you share is voluntary

All information you provide is voluntary. You may be asked some questions about your health and wellbeing to help the practitioner understand your situation, but nothing is required. Share as much or as little as you feel comfortable with. You may leave any question blank, give a general answer instead of details, or tell your practitioner you would rather not discuss something.

You can change your mind at any time: you may add to, correct or withdraw what you have shared, and ask for it to be deleted. Choosing not to share something will not stop you from having a session, although it may mean the practitioner has less to go on.

During the session, you may ask questions, decline any part of it, or stop at any time.

I understand that all information I provide is voluntary, that I choose what and how much to share, and that I can change my mind at any time.

I understand that I may decline any part of the session or stop it at any time.

4. Consent to use my health information

I give my explicit consent for Ayda's Coaching and Trainings LLC and my practitioner to collect, store and use the health and wellbeing information I choose to share, only to prepare for and carry out my sessions and to keep a record of them, as described in the Privacy policy.

I understand that this information will not be used for marketing, will not be sold, and will be shared only with my practitioner and the service providers that store it securely. It may be stored in the United States. I can withdraw this consent at any time by emailing [privacy email]; if I do, the information will be deleted except for this signed consent record, and further sessions may not be possible.

5. The practitioner is responsible for the session

I understand that my practitioner is an independent professional, not an employee of the platform, and is solely responsible for the session, including the meeting link and how the session is run. ACMOS USA provides booking and hosting only.

I take part voluntarily and accept responsibility for my own health decisions.

6. Remote sessions

For remote sessions, the practitioner will send the meeting link. Please join from a private place. Sessions are not recorded unless both of us agree in advance.

7. Electronic signature

I am 18 or older, I have read the Terms of service and Privacy policy, and I agree that typing my name and signing below is my electronic signature and has the same effect as signing on paper.

Full name: ____________________ Signature: ____________________ Date: __________

Email address: ____________________