Intake and Consent/Liability Forms PDF
The undersigned ("client") hereby freely consents to receive services from DEBORAH GOALDMAN, REGISTERED PRACTITIONER OF ORTHO-BIONOMY® AND REIKI MASTER. Client agrees to the following: I have stated all of the conditions that I am aware of, and this information is true and accurate.
I will inform the practitioner of any changes in my status. I understand that there shall be no liability on the practitioner's part should I fail to do so.
I understand that if I become uncomfortable for any reason, I may ask the practitioner to end the Ortho-Bionomy® and/or Reiki session, and she will end the session.
I understand that the practitioner may end the session for behavior that is inappropriate or sexually suggestive, and payment will be expected in full regardless if the session is completed or not.
Client's Printed Name _____________________________________ Date __________
Practitioner's Printed Name Deborah Goaldman Date __________