Introduction
I, the individual signing below (“Participant”), acknowledge that I am voluntarily choosing to participate in services, sessions, consultations, educational activities, and wellness practices provided by Ana Evangelina Mallory through HealWithTouch LLC (“HealWithTouch”).
These services may include in-person or distance sessions, depending on the service being provided.
- Practitioner
- Ana Evangelina Mallory
- Business
- HealWithTouch LLC
Nature of Services
Participant understands that HealWithTouch offers non-invasive wellness, traditional healing, educational, and complementary practices.
Services may include, but are not limited to, SIWA MURTI Balinese healing, Acudetox/auricular acupuncture, Hair Tissue Mineral Analysis (HTMA), German New Medicine/Five Biological Laws educational sessions, kinesiology/muscle testing, Bach flower consultations, Zhineng Qigong, meditation, breath practices, body-awareness practices, and other wellness or educational services offered by HealWithTouch.
Participant understands that these services are not intended to replace emergency care or individualized medical, psychological, or other licensed healthcare services.
No Medical Diagnosis or Medical Treatment
Participant understands that participation in HealWithTouch services does not establish a doctor-patient relationship.
HealWithTouch does not provide emergency medical care and does not diagnose, treat, cure, or prevent medical diseases or conditions through these services.
Participant understands that any information, observations, educational material, testing, or practices provided during a session are not a substitute for evaluation, diagnosis, or treatment by an appropriately licensed healthcare professional.
Participant is encouraged to maintain an appropriate relationship with their healthcare providers and to seek professional medical care when appropriate.
Participant Responsibility
Participant agrees to provide accurate information about relevant health history, medications, allergies, physical limitations, and other circumstances that may be important for participation.
Participant is responsible for determining whether participation is appropriate for their individual circumstances and agrees to communicate any concerns, discomfort, or changes during a session.
Participant understands that they may stop participation in a session at any time.
SIWA MURTI
Participant understands that SIWA MURTI is a traditional Balinese healing practice and that sessions may be conducted in person or through distance sessions.
Participant understands that experiences and responses to SIWA MURTI may vary from person to person and that no particular outcome is guaranteed.
Acudetox / Auricular Acupuncture
Participant understands that Acudetox/auricular acupuncture involves the placement of acupuncture needles in specific points of the outer ear when that service is provided.
Participant understands that acupuncture may involve potential risks, including but not limited to temporary discomfort, tenderness, bruising, minor bleeding, dizziness, or other reactions.
Participant agrees to inform Ana Evangelina Mallory of any relevant conditions, allergies, sensitivities, or concerns before receiving this service.
HTMA — Hair Tissue Mineral Analysis
Participant understands that Hair Tissue Mineral Analysis (HTMA) involves the analysis of a hair sample and that the information provided is intended for educational and wellness purposes.
HTMA results are not intended to independently diagnose a medical condition or replace laboratory testing, medical evaluation, or treatment from a licensed healthcare professional.
Participant understands that recommendations or discussions based on HTMA are educational and wellness-oriented.
German New Medicine / Five Biological Laws
Participant understands that German New Medicine (GNM), also referred to as the Five Biological Laws, may be presented as an educational framework during HealWithTouch sessions.
Information discussed in connection with GNM is educational in nature and is not a medical diagnosis or a substitute for medical evaluation or treatment.
Participant understands that they remain responsible for obtaining appropriate medical care for symptoms, injuries, illnesses, or other health concerns.
Kinesiology, Muscle Testing, Bach Flowers, Qigong, Meditation and Other Practices
Participant understands that kinesiology/muscle testing, Bach flower consultations, Zhineng Qigong, meditation, breathing practices, body-awareness practices, and other complementary practices offered by HealWithTouch are intended for wellness, educational, self-awareness, and complementary purposes.
No particular result or outcome is guaranteed.
Participant understands that individual responses to these practices can vary.
In-Person and Distance Sessions
Participant understands that some HealWithTouch services may be provided in person and others may be provided through distance sessions or remote communication.
Participant understands that distance sessions do not involve physical contact and that the experience and response may vary from person to person.
No Guarantee of Results
Participant understands that HealWithTouch does not guarantee any particular physical, emotional, mental, spiritual, or other outcome from participation in any service.
Assumption of Risk
Participant voluntarily chooses to participate in HealWithTouch services and understands that certain services may involve inherent risks or unexpected reactions.
Participant voluntarily assumes the risks associated with participation to the extent permitted by applicable law.
Release from Liability
To the extent permitted by applicable law, Participant agrees to release and hold harmless Ana Evangelina Mallory, HealWithTouch LLC, and their agents or representatives from claims, liabilities, damages, or demands arising from or related to Participant’s voluntary participation in HealWithTouch services, except where such limitation is prohibited by law.
Covenant Not to Sue
To the extent permitted by applicable law, Participant agrees not to bring or assist in bringing a claim against Ana Evangelina Mallory or HealWithTouch LLC arising from Participant’s voluntary participation in HealWithTouch services, except where such waiver is prohibited by applicable law.
Continuing Agreement
Participant agrees that this General Release and Waiver applies to each HealWithTouch session or service in which Participant voluntarily participates, unless otherwise agreed in writing.
Final acknowledgment
I, THE PARTICIPANT, HAVE READ AND UNDERSTAND THIS GENERAL RELEASE AND WAIVER OF LIABILITY AGREEMENT. I UNDERSTAND THE NATURE OF THE SERVICES BEING OFFERED BY HEALWITHTOUCH LLC AND UNDERSTAND THAT THESE SERVICES ARE NOT A SUBSTITUTE FOR MEDICAL OR OTHER LICENSED HEALTHCARE SERVICES. I UNDERSTAND THAT I AM VOLUNTARILY PARTICIPATING AND THAT I MAY BE GIVING UP CERTAIN LEGAL RIGHTS TO THE EXTENT PERMITTED BY LAW. I ACKNOWLEDGE THAT I AM AT LEAST EIGHTEEN (18) YEARS OF AGE AND AM SIGNING THIS AGREEMENT FREELY AND VOLUNTARILY.