INFORMED CONSENT, WAIVER, AND RELEASE OF LIABILITY FOR COUNSELING AND COACHING SERVICES
By purchasing Amira Ayad (referred to as AA hereafter) coaching and consultation services I (the client, client sponsor, and client representative) hereby fully understand, acknowledge, and agree as follows:
Amira Ayad (AA) consultations, coaching, workshops, and services offer health, wellness, and nutritional information and are designed for educational purposes only. I should not rely on this information as a substitute for, nor does it replace professional medical advice, diagnosis, or treatment. I am encouraged by AA to continue visiting with and being treated by my primary care physician or health care provider. If I have any concerns or questions about my health, I should always consult with a physician or other health care professional. It is my sole responsibility to not disregard, avoid, or delay obtaining medical or health-related advice from my health care professional because of any information I may have received during my consultation, communication, or correspondence with AA. It is my sole responsibility to consult with my own medical professional regarding all foods, nutritional supplements, or herbs to evaluate if they could adversely affect me or react with any medications or pre-existing conditions. The use of any information provided by AA is solely at my own risk. No services, information, or products provided by AA are intended to be, and must not be taken to be, the practice of medical or any other regulated act. For purposes of this agreement, the practice of medical and regulated acts includes, without limitation, psychiatry, psychology, or providing health care treatment, instructions, diagnosis, prognosis, or advice.
Any recommendations I follow for changes in the diet, lifestyle, and behaviors including the use of herbs or nutritional supplements, are entirely my responsibility. In consideration of my participation in AA’s Services, I hereby accept all risks to my health and I hereby release AA, on my behalf and on behalf of my personal representatives, estate, heirs, next of kin, and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, that may result from or occur as a result of any participation in AA Services.
INFORMED CONSENT, WAIVER, AND RELEASE OF LIABILITY FOR COUNSELING AND PSYCHOTHERAPY SERVICES
I further acknowledge and agree that AA is a Registered Psychotherapist in the Province of Ontario, Canada; and that AA might refer to psychotherapeutic tools during the coaching sessions. I understand and agree that AA will explain the process and the therapeutic tools and I understand that I am free to ask questions about the therapy at any time throughout the process. I acknowledge and agree that by engaging in AA coaching, therapy, and counselling services, I do hereby RELEASE, ACQUIT, AND FOREVER DISCHARGE AA, and Women Whispers Academy from any and all actions, courses of action, claims, demands, injuries, damages, costs, loss of service, expenses and compensation, on account of any and all known and unknown personal injuries, mental anguish or agitation, and damage claims to person or property resulting from or arising out of or related to any and all coaching, counselling, psychotherapy, and spiritually integrated psychotherapy services (referred to as the Services hereafter) provided by AA in any way affecting me.
I understand that AA is a Registered Psychotherapist. The services provided by AA will be conducted according to the guidelines and policies adopted by AA, whether or not these policies are set out or written. I understand that AA will adopt all possible means to ensure the confidentiality of the content of the sessions and the protection of my personal health information. I also understand that, by law, there are certain situations in which information about individuals undergoing, counselling and psychotherapy may be released with or without their permission. These situations include things such as: 1. Where children are physically abused, neglected, or sexually abused. 2. In emergency situations where there may be a danger to the client or others. 3. If a court of law issues a legitimate subpoena. 4. If an unreported life-threatening felony has been committed.
I further acknowledge that the services provided by AA are not intended as a substitute for medical treatment and that the services do not involve the diagnosing, prognosticating, treatment of disease, or any act which will constitute the practice of medicine. I understand and agree that should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnosis, or treatment.
I acknowledge and agree that I have had the nature of the services to be provided by AA fully explained to me prior to receiving such Services, and I freely enter into such agreement with full knowledge of the nature of the services I am about to receive.
I knowingly waive and release all claims for damages to my person or property arising out of or in any way related to the financial, psychological, spiritual, and/or mental problems and the counseling and psychotherapy directed at such problems which have brought me to AA for Services. I further agree to indemnify, have and hold harmless AA from any and all claims and damages of every kind to any person or property arising out of or attributed to the financial, spiritual, psychological, physical, financial and/or mental problems which brought me to AA for any and all matters relating to or connected with the circumstances for which the Services are sought at any point after the date of this release. It is further understood and agreed that this waiver and release constitutes an admission and acknowledgment by me that I have received no warranty, guarantee, or promise of any particular result either expressed or implied, from AA. The terms of this waiver and release are contractual and not mere recital. In consideration of my participation in AA’s Services, I hereby accept all risks to my health and I hereby release AA, on my behalf and on behalf of my personal representatives, sponsors, estate, heirs, next of kin and assigns from any and all costs, claims, causes of action and damages arising from any and all illness or injury to my person, that may result from or occur as a result of any participation in the Services.
JURISDICTION WAIVER
I further agree that all aspects of my relationship with AA as well as Women Whispers Academy and their agents, delegates, employees, and any service, therapy, consultation, counselling, education, or coaching provided to me, and the resolution of any and all disputes or claim arising from or in connection with that relationship, including non-contractual disputes or claims, and any disputes arising under or in connection with this agreement, shall be governed by and construed in accordance with the laws of the Province of Ontario and the laws of Canada applicable therein. I agree that the courts of the Province of Ontario shall have exclusive jurisdiction to settle any dispute or claim arising out of or in connection with the subject matter or formation, including non-contractual disputes or claims, of these Terms or from any other aspect of the relationship between myself and AA.
SERVICE FEES
I understand the cost of the Services and agree to pay according to the guidelines set by AA. I understand that payment is due 24 hours before the session to confirm the appointment and that any cancellation should be by email at least 24 hours before the session. I also understand that all fees are non-refundable.