*Please read the waiver carefully. If under the age of 18 years old, a parent or guardian must sign on your behalf.
I, the undersigned, understand that Chanel Stynder is a Homeopathic Practitioner and Energy Realignment Specialist. As such, I acknowledge that it is my responsibility to seek all medical diagnosis and advice for my present and future conditions through my primary care physician. In consulting with Chanel Stynder, I am exercising my right to choose an alternative method of treatment through which to address my total health. As homeopathy is not covered by the existing government insurance plan (Canada), I agree to pay all fees presented in the current rate schedule. I, the undersign, do hereby acknowledge that Chanel Stynder has explained the homeopathic assessment and recommended treatment plan. I have been given the opportunity to ask questions about the homeopathic assessment and recommended treatment plan and have received answers to all of those questions. I confirm that I understand the homeopathic assessment and recommended treatment plan, which included a discussion of the nature of the procedure, expected benefits of homeopathic treatment, potential risks and side effects, as well as the fee schedule for homeopathic consultations. I have also been informed of any alternative courses of action that I can take, and I understand that my consent can be withdrawn at any time during the course of homeopathic treatment. I understand that the information provided will be kept confidential and used only for the purposes of my care.