Client Informed Consent and Disclosure
Notice: this form may not be replicated in part or in whole without written permission from BAR, LLC
BioEnergetic Analysis Resources, LLC
www.bioenergeticresourcesanalysis.com contact@bioenergeticanalysisresources.com ___________________________________________________________
Client Agreement, Consent, & Disclosure Statement
Thank you for your interest in working with BioEnergetic Analysis Resources, LLC, as a client. Your primary Complimentary and Alternative Health Practitioner _________you will type your practioner name/office name in the online acceptance form ______________ is referring you for BioEnergetic Analysis. BioEnergetic Analysis Resources, LLC is providing you with the following information so you can make an informed choice about your decision to engage the services. Please read this information carefully and let your health practitioner overseeing your care if there is something in this you do not understand. BioEnergetic Analysis Resources will be referred to as BAR or BAR, LLC hereafter in this document.
Services Offered/Theoretical Approach
BAR, LLC and its independent contractors offer a holistic and progressive health approach, integrating complementary and alternative medicine energetic assessments, products, and educational information. Specifically, BAR, LLC offers an innovative energy-oriented health evaluation technique within the field of complementary and alternative medicine identified as BioEnergetic Assessments which is designed to energetically evaluate imbalances in the body. A BioEnergetic Assessment is intended as a measurement of resonance and is conducted using a bioenergetic device after the client submits a piece of hair or a swab with saliva. For those clients that choose a BioEnergetic Assessment, once imbalances are identified, the BAR Independent contractor assigned to your case can assist your CAH practitioner who works directly with you to devise a personalized health plan which may include a customized diet, educational materials, products such as homeopathic remedies, nutritional supplements, and other appropriate health products. Although BioEnergetic Assessments appear to have promising emotional, mental, and physical health benefits, they have yet to be fully researched by the Western academic, medical, and psychological communities. Therefore, BioEnergetics Assessments are considered experimental and the extent of their effectiveness, as well as their risks and benefits, are not fully known. BioEnergetics Assessment are considered to be alternative or complementary healing approaches.
Nature of the Relationship
By signing this document you understand that BAR, LLC, is offering services solely as a BioEnergetic Practitioner. No employee or contractor of BAR, LLC is a registered dietician, psychologist, psychotherapist, physician, or other licensed health care provider. Further, you understand BioEnergetic practitioners are self-regulated and are not licensed. Further, you understand BioEnergetics Practitioners do not provide any medical, psychological, or any other licensed health care advice, opinion or service and do not diagnose, treat, or cure any disease, condition, or other physical or mental ailment. Rather BAR, LLC and its indpendant contractors offer complementary and alternative medicine energetic assessments, products, and educational information intended to assist in restoring balance and energetic flow in the body; thereby, creating the opportunity for the body to heal naturally.
Limitations of Practice
Please be advised BioEnergetic Assessments are not intended to be substitutes for medical or psychological diagnosis and treatment and they do not replace the services of a physician, psychotherapist, registered dietician, or any other licensed health care professional. You agree to consult with your licensed health care provider for any specific health care problems and understand that BAR, LLC or any of their Independent Contractors may recommend you contact your licensed health care provider, if it’s believed to be advisable in the best interest of your health. In addition, if you are under the care of a health care professional or currently using prescription medications, you are advised to discuss any dietary changes or potential dietary supplement use with your health care professional. You are also advised that if you are using prescription medications, you should not discontinue any of them without first consulting with your licensed health care professional – especially the one that prescribed them.
Outcome Expectations/Risk & Benefits
While it’s not possible to provide any guarantees regarding your goals, BAR, LLC and the Independent Contractor assigned to your case will work with your referring Alternative and Complimentary Healthcare Practitioner to achieve the best possible results for you. If part of your work with BAR, LLC in any way includes a personalized health plan, BAR, LLC and/or the Independent Contractor assigned to your case may recommend a customized diet and specific products such as homeopathic remedies, nutritional supplements, and other nutritional products. With such a customized diet and specific products recommended to you, it’s possible for you to experience an adverse reaction while your body is going through the detoxification process which can be perceived as a negative side effect. You agree to promptly inform your Alternative and Complimentary Healthcare practitioner overseeing your case in person, if you experience any emotional distress and/or physical discomfort during or between your sessions. If appropriate, they can help refer you to an appropriate professional health care provider for further assistance.
Sale of Products
As a service to clients who embark on a personalized health, BAR, LLC will make some professional line of products available for purchase directly through BAR, LLC. You understand that BAR, LLC has applied a usual and customary markup on these products and that it has a financial interest in this markup.
Acknowledgment and Consent to Receive Services
By signing this document, you agree that BAR LLC and its Independent Contractors have disclosed to you sufficient information to enable you to decide to engage or not engage the services offered. You have obtained whatever information or professional advice you deem necessary to make an informed decision. You understand that your consent to the nature of your session(s) is given voluntarily, without coercion, and may be withdrawn in the future. You represent that you are competent and able to understand the nature and consequences of the proposed session(s) and agree to be personally responsible for the fees related thereto. You have discussed with your Complimentary and Alternative Health Practitioner ordering the BioEnergetic Assessment on your behalf the nature of the services to be provided and you understand that she is offering her services solely as a BioEnergetic Practitioner
You understand BioEnergetic Assessments are relatively new healing approaches and the extent of their effectiveness, as well as their risks and benefits are not fully known. Therefore, if you choose to use BioEnergetic Assessments as part of your program, you agree to assume and accept full responsibility for any and all risks associated with them. Further, you agree and understand this Client Agreement & Disclosure Statement is intended to be a complete unconditional release of liability and assumption of risk to the greatest extent permitted by law.
Any and all matters in dispute between the parties to this Agreement, whether arising from or relating to this Agreement itself, or arising from alleged extra-contractual facts prior to, during, or subsequent to this Agreement, including, without limitation, fraud, misrepresentation, negligence or any other alleged tort or violation of the contract, shall be governed by, construed, and enforced in accordance with the laws of State of Montana, without regard to conflicts of law doctrines and regardless of the legal theory upon which such matter is asserted. This Agreement may not be amended except in writing signed by both parties. No waiver by any party of any right under this Agreement will be construed as a waiver of any other right. If a court finds any provision of this Agreement is invalid or unenforceable as applied to any circumstance, then it is agreed that the balance of this Agreement shall continue in full force and effect and the remainder of this Agreement will be interpreted to best carry out the intent of the parties. This Agreement shall be binding upon you and your heirs, legal representatives, and assigns.
By signing in the space provided below, you knowingly, voluntarily, and intelligently assume these risks and except in the case of gross negligence or malpractice you and your representative(s) agree to forever fully release and hold harmless BioEnergetic Analysis Resources, LLC, its owners, members, principals, employees, staff members, agents, representatives, consultant, independent contractors, and others associated with BioEnergetic Resources Analysis, LLC from and against any and all claims or liability, of whatsoever kind or nature arising out of or in connection with your session(s).
By providing your typed name in the electronic box on your electronic intake form you affirm you have read this document in its entireity and you give consent as of the date of submission for your Complimentary and Alternative Health Practitioner whom you work directly with named to order BioEnergetic Assesments on your behalf and for BioEnergetic Analysis Resources and its employees and independent contractors to release information back to the office of your Complimentary and Alternative Health Practitioner named above.
www.bioenergeticresourcesanalysis.com contact@bioenergeticanalysisresources.com ___________________________________________________________
Client Agreement, Consent, & Disclosure Statement
Thank you for your interest in working with BioEnergetic Analysis Resources, LLC, as a client. Your primary Complimentary and Alternative Health Practitioner _________you will type your practioner name/office name in the online acceptance form ______________ is referring you for BioEnergetic Analysis. BioEnergetic Analysis Resources, LLC is providing you with the following information so you can make an informed choice about your decision to engage the services. Please read this information carefully and let your health practitioner overseeing your care if there is something in this you do not understand. BioEnergetic Analysis Resources will be referred to as BAR or BAR, LLC hereafter in this document.
Services Offered/Theoretical Approach
BAR, LLC and its independent contractors offer a holistic and progressive health approach, integrating complementary and alternative medicine energetic assessments, products, and educational information. Specifically, BAR, LLC offers an innovative energy-oriented health evaluation technique within the field of complementary and alternative medicine identified as BioEnergetic Assessments which is designed to energetically evaluate imbalances in the body. A BioEnergetic Assessment is intended as a measurement of resonance and is conducted using a bioenergetic device after the client submits a piece of hair or a swab with saliva. For those clients that choose a BioEnergetic Assessment, once imbalances are identified, the BAR Independent contractor assigned to your case can assist your CAH practitioner who works directly with you to devise a personalized health plan which may include a customized diet, educational materials, products such as homeopathic remedies, nutritional supplements, and other appropriate health products. Although BioEnergetic Assessments appear to have promising emotional, mental, and physical health benefits, they have yet to be fully researched by the Western academic, medical, and psychological communities. Therefore, BioEnergetics Assessments are considered experimental and the extent of their effectiveness, as well as their risks and benefits, are not fully known. BioEnergetics Assessment are considered to be alternative or complementary healing approaches.
Nature of the Relationship
By signing this document you understand that BAR, LLC, is offering services solely as a BioEnergetic Practitioner. No employee or contractor of BAR, LLC is a registered dietician, psychologist, psychotherapist, physician, or other licensed health care provider. Further, you understand BioEnergetic practitioners are self-regulated and are not licensed. Further, you understand BioEnergetics Practitioners do not provide any medical, psychological, or any other licensed health care advice, opinion or service and do not diagnose, treat, or cure any disease, condition, or other physical or mental ailment. Rather BAR, LLC and its indpendant contractors offer complementary and alternative medicine energetic assessments, products, and educational information intended to assist in restoring balance and energetic flow in the body; thereby, creating the opportunity for the body to heal naturally.
Limitations of Practice
Please be advised BioEnergetic Assessments are not intended to be substitutes for medical or psychological diagnosis and treatment and they do not replace the services of a physician, psychotherapist, registered dietician, or any other licensed health care professional. You agree to consult with your licensed health care provider for any specific health care problems and understand that BAR, LLC or any of their Independent Contractors may recommend you contact your licensed health care provider, if it’s believed to be advisable in the best interest of your health. In addition, if you are under the care of a health care professional or currently using prescription medications, you are advised to discuss any dietary changes or potential dietary supplement use with your health care professional. You are also advised that if you are using prescription medications, you should not discontinue any of them without first consulting with your licensed health care professional – especially the one that prescribed them.
Outcome Expectations/Risk & Benefits
While it’s not possible to provide any guarantees regarding your goals, BAR, LLC and the Independent Contractor assigned to your case will work with your referring Alternative and Complimentary Healthcare Practitioner to achieve the best possible results for you. If part of your work with BAR, LLC in any way includes a personalized health plan, BAR, LLC and/or the Independent Contractor assigned to your case may recommend a customized diet and specific products such as homeopathic remedies, nutritional supplements, and other nutritional products. With such a customized diet and specific products recommended to you, it’s possible for you to experience an adverse reaction while your body is going through the detoxification process which can be perceived as a negative side effect. You agree to promptly inform your Alternative and Complimentary Healthcare practitioner overseeing your case in person, if you experience any emotional distress and/or physical discomfort during or between your sessions. If appropriate, they can help refer you to an appropriate professional health care provider for further assistance.
Sale of Products
As a service to clients who embark on a personalized health, BAR, LLC will make some professional line of products available for purchase directly through BAR, LLC. You understand that BAR, LLC has applied a usual and customary markup on these products and that it has a financial interest in this markup.
Acknowledgment and Consent to Receive Services
By signing this document, you agree that BAR LLC and its Independent Contractors have disclosed to you sufficient information to enable you to decide to engage or not engage the services offered. You have obtained whatever information or professional advice you deem necessary to make an informed decision. You understand that your consent to the nature of your session(s) is given voluntarily, without coercion, and may be withdrawn in the future. You represent that you are competent and able to understand the nature and consequences of the proposed session(s) and agree to be personally responsible for the fees related thereto. You have discussed with your Complimentary and Alternative Health Practitioner ordering the BioEnergetic Assessment on your behalf the nature of the services to be provided and you understand that she is offering her services solely as a BioEnergetic Practitioner
You understand BioEnergetic Assessments are relatively new healing approaches and the extent of their effectiveness, as well as their risks and benefits are not fully known. Therefore, if you choose to use BioEnergetic Assessments as part of your program, you agree to assume and accept full responsibility for any and all risks associated with them. Further, you agree and understand this Client Agreement & Disclosure Statement is intended to be a complete unconditional release of liability and assumption of risk to the greatest extent permitted by law.
Any and all matters in dispute between the parties to this Agreement, whether arising from or relating to this Agreement itself, or arising from alleged extra-contractual facts prior to, during, or subsequent to this Agreement, including, without limitation, fraud, misrepresentation, negligence or any other alleged tort or violation of the contract, shall be governed by, construed, and enforced in accordance with the laws of State of Montana, without regard to conflicts of law doctrines and regardless of the legal theory upon which such matter is asserted. This Agreement may not be amended except in writing signed by both parties. No waiver by any party of any right under this Agreement will be construed as a waiver of any other right. If a court finds any provision of this Agreement is invalid or unenforceable as applied to any circumstance, then it is agreed that the balance of this Agreement shall continue in full force and effect and the remainder of this Agreement will be interpreted to best carry out the intent of the parties. This Agreement shall be binding upon you and your heirs, legal representatives, and assigns.
By signing in the space provided below, you knowingly, voluntarily, and intelligently assume these risks and except in the case of gross negligence or malpractice you and your representative(s) agree to forever fully release and hold harmless BioEnergetic Analysis Resources, LLC, its owners, members, principals, employees, staff members, agents, representatives, consultant, independent contractors, and others associated with BioEnergetic Resources Analysis, LLC from and against any and all claims or liability, of whatsoever kind or nature arising out of or in connection with your session(s).
By providing your typed name in the electronic box on your electronic intake form you affirm you have read this document in its entireity and you give consent as of the date of submission for your Complimentary and Alternative Health Practitioner whom you work directly with named to order BioEnergetic Assesments on your behalf and for BioEnergetic Analysis Resources and its employees and independent contractors to release information back to the office of your Complimentary and Alternative Health Practitioner named above.