Client Liability Waiver & Informed Consent Form

CLIENT LIABILITY WAIVER & INFORMED CONSENT FORM

This document aims to describe the services provided by Mindful Soul Movement LLC and I Am Alchemy, to confirm my understanding and voluntary consent to participate in these offerings. These modalities are holistic, integrative, and spiritual, based on ancient wisdom and sacred practices. They are not medical treatments and are not intended to substitute for professional healthcare or mental health therapy.

1. Ayurvedic Sacral-Crafted Herbal Medicine

This includes but is not limited to herbal oils, elixirs, ghee, tinctures, powders, body pastes, womb compresses, and internal or external herbal remedies prepared through Ayurvedic, feminine, and ritual methods.

I understand that all herbal products and remedies are sacredly crafted from Ayurvedic and ancestral traditions.

I assume full responsibility for how I use these remedies and understand they are not designed to diagnose or cure disease but used to support the body in healing.
I must disclose all known allergies, medical conditions, medications, pregnancy status, and reproductive history before use.
I will discontinue use if I experience any adverse reactions.

2. Breathwork

These practices may include circular, connected, or guided breathing techniques that may result in emotional release, catharsis, or altered states of consciousness.

I understand:

Breathwork may not be appropriate for individuals with cardiovascular issues, epilepsy, bipolar disorder, schizophrenia, severe trauma, or pregnancy.
I will inform the practitioner of any such conditions and am responsible for monitoring my own physical and emotional well-being during the session.
I understand that breathwork may bring up past memories, suppressed emotions, or energetic shifts, and I choose to engage with this consciously and with support.

3. Somatic Movement

These may include guided intuitive movement, womb yoga, grounding practices, and nervous system regulation tools.

I understand:

I am responsible for listening to my body, modifying movements as needed, and choosing rest if discomfort arises.
This is a non-clinical somatic experience and not psychotherapy or physical therapy.

4. Reiki & Energy Healing

Reiki is an energy healing practice that involves light touch or no-touch, intended to balance the body's energy and support emotional, mental, and physical well-being.

I understand:

Reiki is not a substitute for licensed medical care or counseling.
I may experience temperature changes, emotional shifts, or sensations during a session.

5. Ceremonial Cacao

Cacao is a traditional heart medicine used ceremonially to open emotional pathways and enhance inner connection.

I understand:

Cacao contains theobromine and may influence blood pressure, heart rate, or serotonin levels.
I will inform the practitioner if I am taking antidepressants, am sensitive to stimulants, pregnant/nursing, or have a heart condition.
Cacao can induce emotional openness or spiritual experiences and I take full responsibility for my engagement with this medicine.

6. Sound Healing

I understand that sound healing may involve exposure to vibrational frequencies that affect my energy and nervous system.
I may experience emotional release, physical sensations, or altered states during or after the session.
I take responsibility for communicating any sensory or emotional sensitivities beforehand.

CLIENT RESPONSIBILITY & VOLUNTARY PARTICIPATION

By signing this form, I confirm that:

I am voluntarily engaging in the services listed above.
I am solely responsible for my health and well-being throughout and after participation.
I agree to communicate any discomfort, questions, or boundaries clearly to the practitioner.
I understand that no guarantees or specific outcomes are promised.

LIABILITY RELEASE

I hereby release and hold harmless Mindful Soul Movement, LLC and I Am Alchemy, its owner(s), facilitators, staff, and collaborators from any and all liability, claims, demands, or causes of action that may arise from my participation in any and all services rendered. This includes but is not limited to physical injury, allergic reaction, emotional distress, illness, or any unintended effect arising from the use of herbal products, body movement, breathwork, energy healing, or cacao consumption.

CONFIDENTIALITY

All personal information shared is held in sacred confidence, in accordance with ethical standards and privacy practices. Records will not be released to any third party without my written consent unless legally required.

understand that there may be pictures or video taken during the session for purposes of use which may

include social media or any type of advertising or promotion. If I do not consent to the use of media, or have

any questions, I will clearly make the facilitator aware prior to the session

I understand that there may be pictures or video taken during the session for purposes of use which may include social media or any type of advertising or promotion. If I do not consent to the use of media, or have any questions, I will clearly make the facilitator aware prior to the session.

INFORMED CONSENT

I affirm that:

I have read this document fully and clearly understand its contents.
I have had the opportunity to ask questions and receive clarification.
I agree to participate at my own discretion, with full awareness and personal responsibility.