consent & liability waiver

Informed Consent to Treat and Liability Waiver & Release

RELEASE OF ALL LIABILITY

In exchange of the fee paid by you, Keren Ksenia Brown (Bar) and FertilityWorks are providing a service assisting you in mind, body, spirit integration through the use of modalities that may include, but not limited to: nutritional education, sound baths and healing, guided meditations and imagery, chakra balancing, private consultations, wellness coaching, and energy work.

You, the participant, hereby agree to assume all risks associated with any outcome resulting from your participation in Keren Ksenia Brown (Bar) and FertilityWorks programs or classes or private consultation. Side effects may include, but not limited to: emotional release, lightheadedness, mild fatigue, physical tingling, and change in body temperature.

All information and mental or physical activity or guidance and direction are provided during programs, classes, or private consultations to enhance the well-being of you, the participant. It is my responsibility, as participant, to inform the practitioner if any discomfort should arise. It is my responsibility, as participant, to notify the practitioner ahead of treatment of any pre-existing medical conditions or injuries.

By signing this Waiver and Release of liability you agree that neither Keren Ksenia Brown (Bar) nor FertilityWorks shall be responsible for any negative consequence of any kind which is claimed to result from:

1) your participation in any of these programs, activities or consultations; or 

2) from the use of any information learned or obtained during these programs, activities or consultations, including, but not limited to nutritional education, mindset techniques, guided meditations and imagery, sound baths and healing, chakra healing, energy work, wellness coaching, or private consultation provided during FertilityWorks programs, classes, or private consultations.  

By signing this Waiver and Release you further agree not to assert any legal claims of any kind in any form against Keren Ksenia Brown (Bar) and FertilityWorks on any asserted negative consequence resulting from your participation in these programs, classes or private consultations.

By signing this Waiver and Release you acknowledge and agree that Keren Ksenia Brown (Bar) and FertilityWorks, disclaim all liability for any injuries or negative consequence claimed by you to be the result of your participation in these programs, classes, or private consultations.

Keren Ksenia Brown (Bar) is not a physician or psychologist, and the scope of his/her consultation services does not include treatment or diagnosis of specific illnesses or disorders. If I, the client, suspect I may have an ailment or illness that may require medical attention, then it is my responsibility to consult with a licensed physician immediately. Only a licensed physician can prescribe drugs. 

Any mention of drugs in the course of consultation is only for the purpose of providing a complete history of drugs that the client is taking and not for Keren Ksenia Brown (Bar) to judge the appropriateness of the medication. Any change in prescription or dosage is a decision the client makes with his or her physician.

Rather than dealing with treatment of disease, Keren Ksenia Brown (Bar) focuses on wellness and prevention through the use of non-toxic, natural nutritional therapies to achieve optimal health. As a certified nutritional practitioner and fertility specialist, Keren Ksenia Brown (Bar) primarily educates and motivates clients to assume more personal responsibility for their health by adopting a healthy attitude, lifestyle, and diet.

While people generally experience greater health and wellness as a result of embracing a healthier attitude, lifestyle, and diet, Keren Ksenia Brown (Bar) does not promise or guarantee protection from future illness.

By signing below, I acknowledge that I understand that Keren Ksenia Brown (Bar) is a Certified Nutritional Practitioner and not a physician, and that I should see a doctor if I think I have a medical condition. Keren Ksenia Brown (Bar) will not be held liable for failure to diagnose or treat an illness, nor will she/he be liable for failure to prevent future illness.

In addition, I have given Keren Ksenia Brown (Bar) a complete and accurate account of any medical conditions that I may have and any medications that I am taking.

MISSION OF FERTILITYWORKS CLASSES, PROGRAMS AND CONSULTATION

It has been our vision to provide the community with a wellness center devoted to the art of holistic & energy healing. We believe there is a strong connection between mind, body, spirit and the overall well-being of an individual. To that end, we employ techniques such as nutritional education, mindset techniques, meditations, and sound therapy through gongs, singing bowls, and other instruments to promote wellness, relaxation and balance. Our hope is to ignite a journey of self-discovery and an expansion of consciousness that will contribute to life-long health and healing.