Services Liability Waiver
Sacred Shakti
Sign in to Google to save your progress. Learn more
Maya C. Lisboa at Sacred Shakti makes no representations, claims, or guarantees regarding the efficacy of her recommendations. The recommendations are based upon a combination of her Ayurvedic and Massage Therapy knowledge and education. *
Required
1. All services provided by Maya C. Lisboa at Sacred Shakti do not constitute a medical service or health care treatment. *
Required
2. The title of “Certified Ayurvedic Practitioner” is used to indicate the achievement of an Ayurvedic Practitioner qualifications and does not imply that Maya C. Lisboa at is state licensed to practice medicine or mental health in the states of California. *
Required
3. Individualized recommendations are offered and applied as an educational and informative consultation. Any action taken as a result of the consultation is done at the sole discretion of the client. Therefore, it is strongly recommended that in addition to any health consultation that you maintain a relationship with one or more physicians qualified to care for bodily or mental health condition(s). *
Required
4. By signing this informed consent you agree to forever release Maya C. Lisboa, her officers and employees from any and all actions, claims or demands that you, your heirs, next of kin, spouse and legal representatives now have, or may have in the future related in your participation of a natural health consultation. *
Required
5. You agree to be responsible for all legal costs and fees that may result from action(s) on your part or on the part of your representative(s) against us. If a legal case is brought against us, you agree that we shall be judged by the standards and principles of complementary, alternative, and/or holistic medicine and not the standards and principles of consensus conventional medicine. You have the right to have this consent reviewed by your lawyer. *
Required
6. You agree that your signature verifies that you have not been told to discontinue treatments with any other medical specialists or other health care providers. Your signature is being given prior to rendering any service, advice, and/or recommendations whatsoever. *
Required
7. Supplements: Maya C. Lisboa at Sacred Shakti makes available nutritional supplements and other health products. You understand that you are in no way obligated to purchase these products from my office or any other specific location or company. You may freely choose to purchase such products from any source(s) as you wish. Maya C. Lisboa, may profit from the sale of supplements and other products that are made available to her clients. *
Required
Do you agree to willingly enter your signature below, acknowledging that you understand all terms, verbiage (language) and concepts herein? *
Required
I, the undersigned, acknowledge that I have read and understood the contents of this agreement. *
Required
By typing you name below, in lieu of your signature, you acknowledge that you have read, understood and agreed to the terms of this waiver of liability: *
Thank you for taking the time to fill out Sacred Shakti's Services  Liability Waiver.                              
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms