Consent Form

Consent to Receive Services

By my electronic signature at the end of this document, I understand that a Wholistic Wellness session provided by Vanessa Wright, and/or the Wholistic Wellness Center, is intended to enhance relaxation, increase communication within the areas of the body, and educate me about possible energetic or emotional blocks that may be related to pain and disease. Wholistic Wellness is non-invasive, safe, and objective. It utilizes the body’s own innate intelligence to reestablish communication within itself. Vanessa Wright is a Wholistic Wellness Practitioner of BodyTalk and Advanced Reiki; and an Essential Oils Wellness Consultant/Instructor, in practice for 11 years. Her method of treatment is alternative or complementary healing arts that are licensed by the State of California; under Sections 2053.5 and 2053.6 of California’s Business and Professions Code and in compliance with California Senate Bill SB-577. I understand that Wholistic Wellness is not a substitute for medical treatment or medications; and that Vanessa Wright does not diagnose illness or disease nor prescribe medications. I understand that she is not a licensed physician and that services are not licensed by the state of California. I understand that my participation is voluntary and at any time I may choose to end the session. Also, that it includes light tapping and touching energy points on the body. This is done energetically in distance sessions. I understand that any information exchanged during treatment is educational in nature and is to be used at my own discretion. Also, that any information shared during sessions is strictly confidential and will not be released without my prior written consent, except as required by law. I have read and understand the above disclosure about Wholistic Wellness services offered by Vanessa Wright.  By signing this informed consent, I assume full responsibility for my sessions, and will hold harmless Vanessa Wright, as well as the facility/location where treatments are provided. If I have any questions or concerns, I will address these promptly with Vanessa Wright; I hereby authorize her to provide me with her services.Payment is due at the time of service. As this time has been reserved for me, I understand that a 24-hour cancellation notice is expected and that fees may be assessed for missed appointments.

Accept Terms *

I have read and agree to the above Consent for Services.

Signature (If minor, signed by parent or legal guardian): *

On a touch-screen use your finger, on a desktop or laptop use your mouse or touchpad to sign consent.

Print Name: *
Date: *