Informed Consent Form
Please read entire document, then click below to sign digitally.
I understand Tammy Hawksworth is a Licensed Spiritual Health Coach (LSHC) and is qualified to assist and help me surrender to my Higher Power and accept my own self realized, Divine healing on every level of my being. I also understand Tammy Hawksworth is a Certified Raindrop Technique Specialist (CRTS) by and is qualified in performing all services contained within this scope of practices. I also understand Tammy Hawksworth is a Certified Aroma Freedom Technique Practitioner and qualified in performing all services within her scope of practice.
I understand Tammy Hawksworth uses various techniques to support me; relax, detoxify my body from unintentional pollutants I may have eaten, drank, absorbed or inhaled, and to enhance my quality of life. Some of these modalities may include and are not limited to: Raindrop, Vibrational Raindrop, NAT, VAT, Neuro Endocrine Center Balancing(Energy TUNE UP), Aroma Freedom Technique, Mentoring, Facial Harmonics, Vita Flex, Body Language Translations, and Conscious Language. I also understand that Tammy Hawksworth will support me in trusting my own intuitive insights, regarding my own self healing journey. I also understand the various techniques Tammy uses are non-secular in art form and science and often include an application or inhalation of essential oils. I understand using essential oils may help me improve my quality of life. I also understand human response for essential oils may vary considerably and are not predictable because of unique chemistry, make up and intent of each individual.
I also understand all alternative modalities may cause some minor discomfort, and/or some minor to adverse side effects may occur through no fault of my own or Tammy Hawksworth’s. I have read and understand the "Eleven Points to Mention" as a Prelude to Raindrop/Vitaflex and/or the "Statistical Validation of Raindrop Technique" prior to my session. *Please check which you have read. ___Eleven Points to Mention ___Statistical Validation of Raindrop Technique
I understand Tammy Hawksworth uses various techniques to support me; relax, detoxify my body from unintentional pollutants I may have eaten, drank, absorbed or inhaled, and to enhance my quality of life. Some of these modalities may include and are not limited to: Raindrop, Vibrational Raindrop, NAT, VAT, Neuro Endocrine Center Balancing(Energy TUNE UP), Aroma Freedom Technique, Mentoring, Facial Harmonics, Vita Flex, Body Language Translations, and Conscious Language. I also understand that Tammy Hawksworth will support me in trusting my own intuitive insights, regarding my own self healing journey. I also understand the various techniques Tammy uses are non-secular in art form and science and often include an application or inhalation of essential oils. I understand using essential oils may help me improve my quality of life. I also understand human response for essential oils may vary considerably and are not predictable because of unique chemistry, make up and intent of each individual.
I also understand all alternative modalities may cause some minor discomfort, and/or some minor to adverse side effects may occur through no fault of my own or Tammy Hawksworth’s. I have read and understand the "Eleven Points to Mention" as a Prelude to Raindrop/Vitaflex and/or the "Statistical Validation of Raindrop Technique" prior to my session. *Please check which you have read. ___Eleven Points to Mention ___Statistical Validation of Raindrop Technique
I also understand my health is my responsibility. I will advise Tammy Hawksworth of anything I deem required in helping us work together and better achieve my healing result I seek of myself.
I also understand my identity and my information about me, whether I share with Tammy Hawksworth or she discovers on her own, will be held in strict confidence, except when released by me in writing or as required by law. Any illegal actions or activities made known to me are required to be shared with the appropriate authorities by law.
I also understand Tammy Hawksworth will not intentionally or unintentionally suggest any diagnosis, treatment, prescription or cure for any disease, disorder, or condition I may or may not have. I also understand natural therapies offered by Tammy Hawksworth are not substitutions for adequate medical care. I intend in remaining under any current care of my primary care physician or other specialists or will seek them out as I deem necessary for my own medical concerns and or conditions. I also understand if I have or think I have a medical concern, physical, psychological or emotional, Tammy Hawksworth will help me reduce any related stress and refer me to an appropriate professional. I also understand except in extreme cases of gross negligence I, or my representative(s) agree to fully release and hold harmless, Tammy Hawksworth, from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).
I also understand my identity and my information about me, whether I share with Tammy Hawksworth or she discovers on her own, will be held in strict confidence, except when released by me in writing or as required by law. Any illegal actions or activities made known to me are required to be shared with the appropriate authorities by law.
I also understand Tammy Hawksworth will not intentionally or unintentionally suggest any diagnosis, treatment, prescription or cure for any disease, disorder, or condition I may or may not have. I also understand natural therapies offered by Tammy Hawksworth are not substitutions for adequate medical care. I intend in remaining under any current care of my primary care physician or other specialists or will seek them out as I deem necessary for my own medical concerns and or conditions. I also understand if I have or think I have a medical concern, physical, psychological or emotional, Tammy Hawksworth will help me reduce any related stress and refer me to an appropriate professional. I also understand except in extreme cases of gross negligence I, or my representative(s) agree to fully release and hold harmless, Tammy Hawksworth, from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).
I acknowledge I have read and understand my application and consent form. Tammy Hawksworth has answered all of my questions. I agree in allowing Tammy Hawksworth's helping me learn methods for healing myself using natural healing techniques and modalities herein listed.
Client or Legal Guardian or Guest Signature: ________________________________________________Date:_______________________ Printed Name:____________________________________________________Phone:__________________________ E-Mail:________________________________________________________________________________
*For guest attendees (check if person signing is a guest in attendance) ____As a guest in attendance of a client session, I understand that everything I see and hear today, and /or at future dates, is strictly confidential. I also understand it is not legal for me to discuss anything I see & hear today or at any future date, with anybody except Tammy Hawksworth and _______________________________________(client).
