Forms - Individual Systemic Family Constellations Waiver of Liability

Individual Systemic Family Constellations & Inner Wisdom Counseling Waiver of Liability

Name

1. Are you currently seeing a doctor or therapist for any emotional or physical illness?

2. Describe current or past therapies.

3. Are you currently taking any medication?

4. Do you have any medical conditions or serious illnesses that Dorit Brauer should be aware of in order to work with you?

CHECK THE BOX TO ACCEPT THE TERMS:

Statement of Liability Waiver: I am aware of and understand that during and after the Systemic Family Constellation & Transgenerational Healing & Inner Wisdom Counseling appointment I might experience mental, emotional or physical stress. I take full responsibility for my own health and well-being. By signing below, I willingly agree to hold harmless and release from all liability: Dorit Brauer.

Signature

Date

Individual Systemic Family Constellations & Inner Wisdom Counseling Waiver of Liability

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