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I, the undersigned, hereby acknowledge and agree to the following terms and conditions as a client of Down to Earth Wellness Center (“the Center”):
Acknowledgment of Risk: I understand that the services provided by the Center, including but not limited to wellness consultations, IV therapies, functional medicine treatments, and other medical or non-medical services, carry inherent risks. I acknowledge that I have been informed of the possible risks, complications, and potential side effects that may arise from receiving treatments or using the Center’s facilities and services. These risks include, but are not limited to, allergic reactions, injury, discomfort, or any other unforeseen complications.
Voluntary Participation: I voluntarily choose to undergo treatment and services at the Center and understand that I can choose to stop at any time. I confirm that I have provided accurate and complete health information to the best of my knowledge and that I will promptly inform the Center of any changes in my health status during my course of treatment.
Waiver of Liability: By signing the Consent & Authorization Summary Signature Page, I release, discharge, and hold harmless Down to Earth Wellness Center, its owners, employees, contractors, and affiliates, from any and all liability, claims, demands, or actions arising from any injury, damage, or harm that may occur while receiving treatments, using the facilities, or participating in any services provided by the Center. I understand that this release of liability applies to all treatments, procedures, and services, whether provided by the Center directly or through third-party affiliates.
No Guarantees: I acknowledge that the Center does not guarantee any specific outcomes or results from treatments or services provided. I understand that wellness and medical treatments may vary from person to person, and outcomes may depend on individual health factors.
Compliance with Policies: I agree to comply with all policies and procedures outlined by Down to Earth Wellness Center, including but not limited to appointment scheduling, cancellation policies, and payment terms. I understand that failure to comply with these policies may result in termination of services.
Consent for Treatment: I hereby give my consent to the Center’s staff, licensed medical professionals, and practitioners to provide treatments and services as outlined in my care plan. I acknowledge that I have had the opportunity to ask questions regarding my treatment and that all of my questions have been answered to my satisfaction.
Governing Law and Dispute Resolution: This consent and release form shall be governed by the laws of the state in which Down to Earth Wellness Center operates. In the event of any dispute, the parties agree to resolve such disputes through mediation or arbitration before pursuing legal action.
By signing the Consent & Authorization Summary Signature Page, I acknowledge that I have read and understood the terms of this General Liability Consent form. I agree to be bound by the terms outlined above and understand that my participation in services at Down to Earth Wellness Center is at my own risk.