Consent for Treatment and Attendance Policy 
Consent and Attendance
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This is a statement of your rights and responsibilities for our therapeutic relationship. This disclosure is designed to inform you of my professional credentials, types of programs offered, and provide written record of your consent to proceed with the and potential program discussed. By signing and dating below I certify that I understand and agree to the following: 

1) Erin Passarello, LLC, agents, and asigned DBAs, utilize multiple modalities and interventions which can/ may include but are not limited to: Earth based practices, dance, movement, physical therapy (within the standard scope of practice within the state of North Carolina), CranioSacral Therapy, Visceral Manipulation, energy work, chakra balancing, and / or coaching regarding nutrition and a home program. I, the client, am responsible for communicating my physical and emotional needs at all times and am choosing to take responsibility for my own health, and that my participation is voluntary and may be withdrawn at any time. 

2) that medical insurance will not be billed. 

3) that Erin Passarello, LLC and assigned agents don't treat mental health issues. 

4) that sessions may move beyond the world of the physical, and that sessions require my full participation, readiness, and honesty.

5) 24 hour notice is required for rescheduling and in failing do so, I will incur a fee of $100 to be paid in full prior to rescheduling. *Exceptions: inclement weather, emergency, or illness- I am advised to cancel a scheduled appointment if I have been running a fever, have vomited, or have cold/ flu symptoms within the last 72 hours. I understand that if my appointment is canceled by Erin Passarello, LLC for any of the above reasons that I will incur NO fee nor will I receive payment. 

6) that if I cancel with less than 24 hours notice or no show (no show, no call) two times that I will be discharged from services. 

7) I further certify that I am over the age of eighteen (18), or the guardian of the minor, and consent for the treatment of such minor. 

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