Loading...

Introduction to Liability and Informed Consent Waiver and Release

Please read this waiver thoroughly and understand the following information below. By initialing and signing this waiver, you acknowledge receipt of the information and policies as listed throughout. You further acknowledge that you have read, understand and accept each statement and policy in its entirety. 


Acknowledgement & Understanding of HH Collective Wellness as an online collaborative Platform

HH Collective/HH Collective Wellness is an online collaborative virtual platform where various independent Healers & Practitioners are able to present information on their offerings/modalities & be booked for sessions & services in those respective modalities. Each person associated with and/or available on www.hhcollectivewellness.com and www.hhcollectivewellness.com.as.me, (Carina Leuenberger, Debra A Loshbough, Glenda Emory, Scott Logan, Ryan Gagala) serves as their own legal entity and is solely responsible for their own sessions/services, modalities, education, integrity, insight, suggestions and client interactions/conversations. The Founder of this online platform, Carina Leuenberger (as Carina Hart), and all Healers, Readers & Practitioners associated with it, are in no way liable for any other person associated on this platform. 



Liability and Informed Consent Waiver and Release

By signing this waiver, you understand & assume any and all risks associated with any and all services/sessions/products offered on www.hhcollectivewellness.com and www.hhcollectivewellness.as.me. You understand and assume any and all risks with following any suggestions or insight provided by any of the following Persons, Independent Healers, and Practitioners connected to or offered on the HH Collective Wellness platform listed by name in Section A; as well as any one-time or part time additional collaborative Persons not listed in Section A. By signing this waiver, you are doing so at your discretion and confirm that you are doing so at your own free-will.

Section A: Carina Leuenberger (Carina Hart) who operates in the following: Founder, CEO of Day to Day operations, Coaching & insight in the following: Integrative Health, non-toxic living, wellness life coaching and holistic nutrition. Debra A. Loshbough, who operates in the following: various Energetic Healing, Atlas Balancing/Dao Tha, Spiritual Response Therapy and BioEnergetic Transmission. Glenda Emory who operates in the following: Quantum Healer, Energy Healer, Health Intuitive, Chakra Balancing & House Clearings Specialist. Scott Logan who operates in the following : Quantum Realm Spiritual Specialist, Health Intuitive & Energy Reader/Finder/Corrector, Ryan Gagala who operates as a Transformative Energy Healer & Spiritual Guide/Coach, as well as Holistic Hart LLC.

I hereby consent to the services within the scope of the practice of the above mentioned names in Section A and any of their offerings, (or on behalf of the client named below, for whom I am legally signing and responsible for) or any Persons associated with or serving as back-up for the Energy & Integrative Practitioners named above, including those working as part of the HH Collective website, whether signatories to this form or not.

Rather than dealing with the diagnosis or treatment of disease, which is left for Allopathic Medicine & Medical Doctors; Carina Leuenberger (as Carina Hart), Debra A. Loshbough, Glenda Emory and Scott Logan, Ryan Gagala, work within their own scope of modality to improve and harmonize the body's natural innate healing response and harmonizing the energetic fields of the body. Furthermore, each party in their own modality aims to educate and motivate clients to take full responsibility for their own health by adopting a healthy lifestyle and nutritional scope of intake, as well as encouraging their own research on choices they make for themselves & their families.

You thereby agree to accept responsibility for your own health and any risk related to receiving a session or sessions, and to hold harmless, Carina Leuenberger as Carina Hart, Debra A. Loshbough, Glenda Emory, Scott Logan, Ryan Gagala and Holistic Hart LLC - from any claim resulting from these sessions. These are NOT medical services and you are full acknowledgement of this. 

By signing this waiver, I understand that nothing offered on www.hhcollectivewellness.com and hhcollectivewellness.as.me; is to replace or substitute for medical treatment by other healthcare professionals. I also understand that the Persons named in Section A, may make suggestions for self-care as well as appropriate referrals, to which is it fully up to the client to decide to pursue or not. 

While people generally experience greater health and wellness as a result of harmonized energetic fields and from embracing a healthier lifestyle & nutrition, there is no promise or guarantee of healing or protection from illness. Furthermore, the number of sessions recommended and results obtained will vary for each individual since we are all unique. While energy healing works with the body and not against it, some individuals are more sensitive to shifts in energy and I agree to notify my energy or integrative practitioner listed above/below of any unpleasant effects I may experience and think could be related. I acknowledge and release all liability and hold harmless, Carina Leuenberger (Carina Hart), Debra A. Loshbough, Glenda Emory, Scott Logan, Ryan Gagala and Holistic Hart LLC - for any possible effects that may cause temporary physical or emotional discomfort and agree to take full responsibility for my self-care and personal development. I am in control of my own body, self and journey, and I can always “stop” at anytime. I choose what to move forward with or not in any and all capacity. I do not expect the Energy or Integrative Practitioner to be able to anticipate and explain all possible results or risks and I trust said Person to exercise their highest judgement during the course of working together, based upon the facts then known and for my best interest and highest good. I understand that any and all results are not guaranteed and release all liability. 



Final Acknowledgement

I acknowledge that any questions I had have been asked and answered and that there is open communication promoted by me and said Person/Energy/Integrative Healer or Practitioner associated with www.hhcollectivewellness.com, to enhance a mutual understanding and acceptance of the services provided by them. 

I understand that all information and records of services & sessions, will be kept confidential between myself and the parties in Section A, or any other practitioners associated on 'hhcollectivewellness.com' and will not be released to anyone else, without my written consent.

I have been informed of the fees for service, and I understand that payment is due upfront for Initial sessions and the day of for follow ups. For all remote sessions payment is due upon purchase of said remote session. I acknowledge that if i do not cancel a 1:1 Zoom based appointment at least 36 hours in advance, then I am liable for anywhere between 25-100% of the full session fee.

By voluntarily signing below, I show that I have read, or have had read to me, the above consent & disclaimer to this platform and these services. I understand any and all risks associated with. I intend this consent form to cover the entire course of my services and sessions with any of the following in Section A, or any other Healers not mentioned by name that are on or in connection to 'hhcollectivewellness.com' for my present state and any future states for which I seek their services.

I,


am here to take personal responsibility for my well-being and I accept full control of my choices. I alone am solely and personally responsible for the results, and my success depends primarily on my own effort, motivation, commitment and follow through.

My heirs, guardians, legal representatives, and I, hereby and forever release, waive, and discharge any claims against any of the following named independent entities in Section A, and other associations to HH Collective Wellness.

I take full responsibility for all liability for loss or injury incurred while in association with or applying any of the following: energy techniques, suggested lifestyle, dietary and vitamin/nutrient recommendations, herbal and/or homeopathic remedies, flower essences, advice, insight, and information given by the above listed Persons and associates with 'hhcollectivewellness.com.' 

I understand that these Persons, services & suggestions cannot and do not diagnose, treat or cure any disease or condition, nor do they prescribe medications or interfere with the treatment of a licensed Medical Doctor or similar Professional. I further understand that the services provided are not meant to be used in place of allopathic or emergency medical care. I agree that it is in my best interest to retain a primary care provider (ND, D.O.M., M.D., or D.O) to assess my health care needs. 

I have carefully read this agreement and fully understand its content. I am aware that this is a waiver and release of all and any potential liability and governs as a contract between the above noted parties and myself. I understand that this contract is binding and acknowledge that I am signing this of my own free will. 

 















First Participant(s) Name

First Name*

Last Name*

Phone*
First Participant(s) Date of Birth*
First Participant(s) Signature*
Second Participant(s) Name

First Name*

Last Name*
Second Participant(s) Date of Birth*
Third Participant(s) Name

First Name*

Last Name*
Third Participant(s) Date of Birth*
Fourth Participant(s) Name

First Name*

Last Name*
Fourth Participant(s) Date of Birth*
Fifth Participant(s) Name

First Name*

Last Name*
Fifth Participant(s) Date of Birth*
Sixth Participant(s) Name

First Name*

Last Name*
Sixth Participant(s) Date of Birth*
Seventh Participant(s) Name

First Name*

Last Name*
Seventh Participant(s) Date of Birth*
Eighth Participant(s) Name

First Name*

Last Name*
Eighth Participant(s) Date of Birth*
Ninth Participant(s) Name

First Name*

Last Name*
Ninth Participant(s) Date of Birth*
Tenth Participant(s) Name

First Name*

Last Name*
Tenth Participant(s) Date of Birth*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!