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Consent Form

INFORMED CONSENT, LIABILITY WAIVER & CLIENT RIGHTS AGREEMENT

1. Scope of Services

Aayusara Wellness provides integrative wellness services including, but not limited to:
● Ayurvedic consultations (preventive and curative)
● Body-based therapies (Abhyanga, Basti therapies, Swedana, Pinda Sweda, etc.)
● Energy-based services (Biofield Imaging, energy balancing, sound-based practices)
● Meditation, breathwork, and mindfulness practices
● Intuitive sessions (Akashic Records and similar modalities)
These services are intended to support general wellness, relaxation, stress reduction, and self-awareness.

2. Not Medical Care

I understand that:
● These services are not medical diagnosis or treatment.
● They are not a substitute for licensed medical care.
● I should consult my physician for any medical condition.
I agree not to discontinue any medical treatment without consulting my healthcare provider.

3. Client Responsibility

I acknowledge that:
● My participation is voluntary
● I will disclose all relevant health conditions, medications, pregnancy status, or injuries
● I will communicate discomfort at any time

4. Energy & Intuitive Services Disclaimer

I understand that:
● Energy-based and intuitive services are complementary and exploratory
● They are intended for personal insight and awareness
● They do not diagnose or treat medical or psychological conditions

5. Consent for Physical Therapies

I consent to:
● Application of oils, heat, and therapeutic techniques
● Possible temporary effects such as soreness, detox responses, or emotional release

6. No Guarantee of Results

I understand that outcomes vary and no specific results are guaranteed.

7. Liability Release

I release and hold harmless Aayusara Wellness and its practitioners from any liability arising from my participation, to the fullest extent permitted by law.

8. Practitioner’s Right to Refuse, Modify, or Discontinue Services

In accordance with applicable laws and standards of practice in the State of New Jersey, Aayusara Wellness and its practitioners reserve the right to refuse, modify, or discontinue services at any time, including but not limited to the following circumstances:
• When a client’s condition is outside the practitioner’s scope of practice
• When services are not appropriate for the client’s current health status
• When there is a potential risk to the client’s safety or well-being
• When the client has not disclosed relevant health information necessary for safe service delivery
• When there is non-compliance with agreed-upon guidelines or recommendations that may impact safety
• When there is inappropriate, disruptive, or unsafe behavior
• When continuation of services is not in the client’s best interest, as determined by the practitioner
In such cases, the practitioner may recommend that the client seek evaluation or care from a licensed physician or other qualified healthcare provider, as appropriate.
Aayusara Wellness also reserves the right to reschedule or modify services if necessary to ensure safe and appropriate care.
Any decision to refuse or discontinue services will be made in a non-discriminatory manner and in accordance with applicable state and federal laws.

9. Client bill of rights

I understand that I have the right to:
• Be treated with respect, dignity, and compassion
• Receive clear information about services
• Ask questions and receive understandable answers
• Make informed decisions about my care
• Decline or discontinue any service
• Receive services in a safe, professional setting
• Expect confidentiality of personal information
• Be informed of fees and policies
• Request access to my records

10. Privacy & confidentiality

Aayusara Wellness follows HIPAA-style privacy practices:
• All personal and health information is kept confidential
• Information is not shared without written consent unless required by law
• Records are stored securely (digital or physical)
• Clients may request access or corrections to their records

11. Telehealth consent

I understand that telehealth sessions may include consultations conducted via video, phone, or digital platforms.
I acknowledge that:
• Telehealth has limitations compared to in-person sessions
• There may be risks related to technology (e.g., interruptions, data breaches)
• I am responsible for ensuring a private and safe environment during sessions
• I may withdraw consent for telehealth at any time

12. Minor consent (if applicable)

For clients under 18 years of age:
I, the undersigned parent or legal guardian, consent to services for the minor named below.
I acknowledge that:
• I am legally authorized to provide consent
• I understand the nature of services provided
• I accept responsibility for the minor’s participation

Minor’s Name:

13. Cancellation & Refund Policy

• 24-hour notice required for cancellations
• Late cancellations or no-shows may be charged full session fee
• Refunds are not provided for completed sessions
• Packages/services are non-transferable unless stated otherwise

14. Consent & Acknowledgment

By signing below, I confirm that:
• I have read and understood this agreement
• I have had the opportunity to ask questions
• I voluntarily consent to receive services

E-Signature

Full Name:

Date:

Phone:

Email:

Date of Birth

For Minor (if applicable):

Parent/Guardian Name: