Health Consent Waiver
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Health Consent & Waiver
- I understand that it is my choice to receive and participate in this service/treatment/event/challenge provided by DeNatura® Wellness and agree it is for my wellbeing including stress reduction, help with pain and tension relief, fitness, energy flow, mindfulness, weight management, nutrition and/or general health.
- I fully understand that there is no implied or stated guarantee of success or effectiveness of a specific service, treatment or series of treatments and that these are not a substitute for conventional medical examination and diagnosis, for which I will see my primary care provider. I will notify my practitioner should I become pregnant or if I am in the process of trying to get pregnant, as well as of any new medical conditions, accidents, falls and/or medications I may be taking.
- I give permission to DeNatura® Wellness to review my personal records and understand my data will be kept confidential. I understand DeNatura® Wellness will use my data to coordinate, assess and make group and individual health, wellbeing and dietary recommendations. I agree and allow DeNatura® Wellness to use my personal data for the purposes of measuring and tracking success, and I agree to be contacted directly with service or product recommendations, promotions, information, reminders, recipes, motivational and or other supportive material. I give permission to DeNatura® Wellness to share the information with our insurance broker for the purposes of tracking the effectiveness of this and future initiatives. I give permission to DeNatura® Wellness to contact me and send me material required for the successful participation in this initiative. I understand it is my choice to choose which dietary program I prefer, if any, and that I may experience dizziness, headaches, changes in blood pressure, discomfort and/or other reactions due to changing my eating habits. I agree to immediately notify DeNatura® Wellness if I feel any discomfort, pain or if I feel my wellbeing is compromised. I agree to provide truthful and honest personal measurements and data during the course of this service/treatment/event. I understand that photography and or video may be taken during a service/treatment/event and I waive all rights to copyright or compensation for such media recording. I understand and agree to DeNatura® Wellness will using such media for the purposes of marketing their programs and services to the general public.
- I understand images and video may be taken during services for publicity, copyright purposes, illustrations, advertising, social media and/or web content. I understand that no royalty or compensation shall be paid to me for any reason and that images will be stored safely and used as long as they are relevant. I understand it is my responsibility to personally notify DeNatura® Wellness in writing should I wish to revoke this authorization and that the revocation will not affect any actions taken before the acknowledged receipt of my written notification.
- I understand that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of my treatment/service and no refund or credit for such session will be provided. I understand and agree to be liable for a one thousand dollar penalty in the event I contact or solicit services directly from a DeNatura® Wellness therapist/instructor/provider and/or agent without the explicit DeNatura® Wellness Director’s written consent, and that services may be permanently terminated should this occur.
- By participating in these services/treatments I hereby accept any and all risks to the extent allowable by applicable law, and absolve, release, indemnify, protect and hold DeNatura® Wellness and its professional contracted staff and agents harmless from any and all liability, including attorney fees and costs, for the consequences arising out of any accident or injury, whether mental or physical in nature to myself, and for affirmative acts or acts of omission and/or active or passive negligence which may arise during the performance of this agreement.