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Intake Form for Elaine Ziner

Saltara Healing, LLC

17 River St (Ste 9) Warwick, NY 10990

Intake Form for Elaine Ziner

 

By acknowledging this waiver, I (client) agree that I am fully aware that the services provided at Saltara Healing are of a holistic nature and do not serve as a substitute for medical or psychiatric advice, examination, diagnosis, or treatment. 


I (client) agree to consult with my doctor or wellness team if I have questions regarding any of the services provided by Saltara Healing. I will make my own well-informed decisions based on what is best for my unique genetics, culture, conditions, and stage of life. 


I (client) agree to assume full responsibility for any and all inherent risks, injuries, or damages, known or unknown, which might occur as a result of participating in any class, private session, service, or workshop at Saltara Healing, LLC. 


I (client) understand that my information is protected and give consent to Saltara Healing, LLC to store and use personal details; I acknowledge that I have given such information for the provider's use. 


I (client) understand that payment is immediately due for services rendered. All Saltara Healing sales are final; and all packages, auto-pays, and gift certificates are non-refundable and non-transferable to others. 


Appointments must be rescheduled or canceled 24 hours in advance. I (client) understand that I will be automatically charged in full for a late-cancel or no-show. If I have a package, a session will be deducted from my package.


By signing this document, I acknowledge that I have read and agree to the details outlined in this agreement.

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