Consent form

Please fill in this consent form either online (below) or download this Word version to email back to Jane.

Consent

I understand that Jane Fowler does not claim to cure any illness or disease physical or mental health issues with any Alternative Therapies.

• I take full responsibility for my health and wellbeing and accept that any advice or therapy I receive from Jane Fowler is complementary and not a substitute for professional medical treatment. I understand that these therapies and procedures do not diagnose disease.
• I understand that Touch for Health Kinesiology is a touch-based therapy, and I give permission for my body to be touched by Jane Fowler. I will inform her if there are any areas of my body I do not wish to be touched.
• I understand that I must inform Jane Fowler fully of any existing medical or mental health conditions.
• I understand that if Jane Fowler offers emotional coaching techniques, these are not a replacement for counselling, psychotherapy, or psychiatric care. I will continue with any treatments or medications prescribed by my mental health professionals. If any work during the session triggers pre-existing mental health issues, I will consult my mental health provider.
• I understand that I must continue all medications and treatments prescribed by my doctor unless advised otherwise by the prescribing doctor.
• I understand that I must disclose any history of anaphylaxis (severe allergic reactions) before treatment begins, so every effort can be made to avoid direct contact with allergens and to ensure my safety.
• I understand that my clinic notes, and personal data will be stored securely and retained for 7 years, after which they will be securely disposed of. I have the right to access my notes at any time.