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Waiver of Liability

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DISCLAIMERS

I understand that the role of [ORGANIZATION/PROVIDER NAME] is not to [INSERT DETAILS]. I am aware that they are not acting in the capacity of a [INSERT DETAILS - EXAMPLE: Medical Doctor]. I understand that any advice given by [ORGANIZATION/PROVIDER NAME] is not meant to take the place of advice by these professionals.

I understand that if I am under the care of other healthcare professionals and/or currently use prescription medications, I should discuss any changes with my doctor and should not discontinue any prescription medications without first consulting my doctor.

I agree that I have chosen to work with [ORGANIZATION/PROVIDER NAME] and understand that the information received is not meant to take the place of other licensed health professionals.


PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS

I acknowledge that I, the Client, take full responsibility for my life and well-being, as well as the lives and well-being of my family and children (where applicable), and all decisions made during and after the services provided. I assume the risks of the Program/Services.

I release [ORGANIZATION/PROVIDER NAME] from any and all liability, damages, causes of action, allegations, suits, sums of money, claims, and demands whatsoever, in law or equity, which I, the Client, ever had, now has, or will have in the future against the provider, arising from my past or future participation in, or otherwise with respect to, the Program/Services, unless arising from the gross negligence of [ORGANIZATION NAME/PROVIDER].

CONFIDENTIALITY

[ORGANIZATION/PROVIDER NAME] will keep the Client’s information private and will not share my, the Client’s, information with any third party unless compelled to by law.

WAIVER OF LIABILITY AND INDEMNIFICATION

I acknowledge that I am voluntarily participating in the services provided by [ORGANIZATION/PROVIDER NAME], and agree to the following:

  • I waive, release, and discharge [ORGANIZATION/PROVIDER NAME] and their employees from any and all negligence and liability for my death, disability, personal injury, property damages, property theft, or claims of any nature which may hereafter accrue to me and my estate as a direct or indirect result of my participation in their services.

  • I agree to defend, indemnify, and hold harmless [ORGANIZATION/PROVIDER NAME] and their employees against any and all claims of any nature including all costs, expenses, and attorneys' fees, which in any manner result from my participation in their services.

I agree to terms and conditions

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