HEALTH AND SAFETY, WAIVER AND RELEASE FORM | SOMATIC PERSONAL RESONANCE EDUCATION
I hereby voluntarily request to receive services from Victoria Vinson-Jacobs, SPRE® Practitioner. I consent and understand that these services will include physical touch and potentially the use of singing bowls on the body. I acknowledge that no guarantees have been made to me as to the effect of such care.
I further acknowledge that the above service is not meant to be construed by me as the diagnosis or treatment of disease, but rather as an aid to balancing my general wellness. Therefore, in consideration for my participation in SPRE®, I personally and on behalf of anyone competent to make claims on my behalf, waive any and all claims and assume all risk of loss, damage or injury associated with or incurred during my participation with my SPRE® Practitioner.
I recognize that I am responsible for my health and well-being, and that it is my duty to myself to be an informed partner in the care I receive. To this end, I will secure the self-knowledge that I need in order to fully work with my SPRE® Practitioner.
I confirm that my physical condition allows me to participate in SPRE®, if I have any questions about my physical condition in this regard, I will seek a physician’s advice.
Additional COVID-19 Considerations:
• Masks are optional and your Practitioner is happy to wear one as requested. Masks are provided if needed.
• Please cancel your appointment and stay home if you feel any symptoms of COVID-19 as listed by the CDC or any other potential contagious illness: fever or chills, cough, shortness of breath/difficulty in breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea. Your Practitioner will follow the same guidelines regarding symptoms.
I have read and understand the foregoing and voluntarily sign this Waiver and Release Form.
Payment & Cancellation Policy
I understand that payment by cash, check, Zelle or cc is due at the time of service. I understand that 48 hours notice of cancellation is required. There is no charge for cancellations received with more than 48 hour notice. For cancellations without notice or with less than 48 hours notice, a full session fee is charged.