INFORMED CONSENT AND LIABILITY AGREEMENT

When booking an appointment you voluntarily check that you have read and agree to this Informed Consent and Liability Waiver & Release, which certifies that you are seeking the consultation and healing services of Shannon Kelley Poulos, PsyD, RM and One Earth Wellness/Golden Tree, LLC for alternative healing sessions for yourself or your minor child, which you fully understand are not psychological or medical diagnoses or treatments.

By agreeing, you acknowledge that in exchange for the fee paid, Shannon Kelley Poulos, Psy D, RM of One Earth Wellness/Golden Tree, LLC is providing a service through various alternative health modalities that may include Reiki/energy healing, intuitive guidance, guided meditations and imagery, and crystal and sound bath healing. You agree to assume all risks associated with any outcome resulting in your participation.  Side effects may include, but are not limited to:  emotional release, lightheadedness, mild fatigue, physical tingling, and change in body temperature.

All information and guidance given during the session is done with the intention to enhance your well-being.  It is your responsibility to inform Shannon Kelley Poulos, Psy D, RM if any discomfort should arise during the session.  It is also your responsibility to disclose ahead of your session of any pre-existing medical conditions, injuries, or electrical medical devices.

By agreeing to the Informed Consent and Liability Waiver & Release form, you agree not to assert any legal claims of any kind in any form against Shannon Kelley Poulos, PsyD, RM and One Earth Wellness/Golden Tree, LLC on any asserted negative consequence resulting from my, or my minor child's, session.

Thank you!