TRE® Private Session Information and Waiver Form
Thank you in advance for taking the time to complete this form. Please note your information is confidential and will not be shared with anyone. Only in case of an emergency will the necessary information be shared with your preferred Medical Practitioner you name below. This information ensures a smooth flowing session and your safety.
The TRE® Private Session is NOT for you if you:
- You have an untreated major medical issue; broken bones or sprains; or recent surgery still under physician’s care.
- Are having difficulty or struggle with bipolar disorder; schizophrenia; manic/depressive; psychosis; severe untreated depression; borderline personality disorder; or untreated PTSD.
- If practicing alone with a qualified practitioner makes you feel unsafe.
- If the idea of having your body moved for you feels overwhelming.
- Diagnosed or have Epilepsy.
- Are currently pregnant.
If any of the above applies to you, I will reach out to you privately to discuss the possibility of rather doing a Private TRE® Session with a provider that is specialized in your area of concern.
Out of an abundance of caution we will not be able to teach you TRE® if you are currently pregnant or are diagnosed with Epilepsy.
CONFIDENTIALITY CLAUSE:
Everything discussed within the confines of the time of work together shall remain confidential and shall not be divulged to any third party by your TRE® Provider, unless in the case there is a medical emergency. If you are participating in group work, no identifying material is to be divulged outside of the group.
By saving and sending this form you confirm that you undertake this session and the treatment of your own accord and accordingly indemnify the TRE® Provider from any harm, loss, or damages of any nature, whether bodily harm, trauma or any other damages to your person or property resulting from the session, treatment, whether directly or indirectly. You also consent to and agree that you will be participating in physical exercise movements and breathwork and you have consulted with your medical practitioner prior to completing this form and session to ensure that it is safe for you to do so. Accordingly, you indemnify the TRE® Provider from any harm, loss, or damages of any nature, whether bodily harm, trauma or any other damages to your person or property resulting from the session, treatment, movement and breathwork whether directly or indirectly.
You agree and understand that physical hands-on interventions (touch) and or props like soft balls, cushions etc may be used from time to time during a TRE® session to assist in the process of the tremors moving through the body. You confirm, understand, and agree that the private booked session may be ended at any time by your TRE® Provider during the booked consultation / session should the TRE® Provider feel that it is not safe for you or her to continue.
Please note: No refunds, credits or rescheduling will be done or given on sessions ended earlier by the TRE® provider or any cancellations or rescheduling of sessions made by you.
By law, we are required to collect this information.
Please take the time to also read Ananda Wellness Refund & Cancellation Policy.
