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Health Waiver & Consent For Treatment


I, understand that La Luna SoL offers holistic therapies and non-traditional

complementary interventions such as Reiki, Sound Healing,Energy work and other holistic modalities ,all of which

are intended to promote health and wellness, enhance relaxation, reduce pain, become relaxed and

more comfortable with your own thoughts, letting go of tensions and apprehensions caused by stress,

emotional barriers and physical /mental illnesses and offer a positive experience utilizing the concept

of mind, body, and soul in treatment intervention.

I understand that my practitioner is trained Reiki Practitioner, Holistic Wellness Coach and is not a

massage therapist, chiropractic doctor, registered nurse, registered dietitian, nor a medical doctor.

I understand, the practitioner is not qualified to diagnose, treat, cure, prevent or assess any disease,

disorder or condition. I understand, the practitioner is not qualified to prescribe medication or dietary

alternatives.

I understand that holistic therapy interventions are not a substitute for medical treatment or

medications, and that it is recommended that I concurrently work with my primary healthcare provider

for any condition I may have. I am aware that the practitioner does not diagnose illness or disease,

does not prescribe medications, and that spinal manipulations are not part of holistic therapy.

I wholeheartedly understand that following any set regime does not promise any form or level of cure

for any specific (or otherwise) condition. I promise to abide by any warnings or contra-indications

given to me through consultation if products and services are used.

I understand that I am under no obligation to follow any recommendations for treatment given.

I have informed the practitioner of all my known physical and medical conditions, and I will keep the

practitioner updated of any changes. I will notify the practitioner should I become pregnant of if I am

trying to become pregnant.

I understand the practitioner and administrative staff may review my medical records and reports, but

all of my records will be kept confidential and will not be released without my written consent.

I have read and understand this consent to treatment. I have been informed about the risks and

benefits of holistic therapy procedures. I intend this consent form to cover the entire course of

treatment for my present condition and for any future conditions for which I seek treatment.

I consent and understand that I may discontinue a session or sessions at any time. If I have been

diagnosed by a licensed health professional as having any disease, injury or other physical or mental

condition, I understand that I should inform the person who made the diagnosis, about the session I will be receiving, and whether or not I intend to discontinue any treatment or therapy which had been

previously ordered, prescribed or recommended by a licensed health professional. I understand that

by discontinuing any such treatment or therapy, I assume responsibility for any negative outcome

resulting from discontinuing that treatment or therapy. I, the undersigned, hereby confirm that the

information provided above is true and accurate to the best of my knowledge. I understand that the

practitioners at La Luna SoL are not medical providers, and their services do not

replace the advice or treatment of a qualified healthcare professional. I acknowledge that I am

responsible for informing the practitioner of any changes to my health status.

Health Waiver Form  

Contact Information 

 

570-426-3672

267-671-3612

Pottstown, Pa 19464

*Physical address shared upon booking&

payment.

​

Cancellation Policy

Should you need to cancel your scheduled session, your payment will be credited towards your future reservations.

We do not offer refunds for reserved appointments.

If for any reason our practitioner reschedules or cancels your reserved session we will hold your credit for your future appointment.

​

 Our Hours

Mon- 10am-9pm | Tue -10am-9pm | Wed- 10am-9pm| Thu- 10am-9pm | Fri- 11am-9pm | Sat- 11:30am-5pm Sunday- Closed

©2022 by La Luna SoL™

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La Luna SoL in no way represents or warrants that your use of materials displayed on this site does not infringe the rights of third parties. 2. Links. You may not establish a link to this site in any way that implies an endorsement or business agreement with La Luna SoL without the express written consent of the General Counsel of La Luna SoL. Please note that this site is linked to other sites which may have different terms of use. Please refer to those sites for the appropriate information. 3. Accuracy. While making reasonable efforts to ensure that all information in this site is accurate and up to date, La Luna SoL makes no representation or warranty of the accuracy, reliability, or completeness of the information. 4. Specific disclaimer concerning medical information. The information provided in this website is for informational purposes only. It is not a substitute for medical advice. All medical information presented should be discussed with your health care professional. Remember, the failure to seek timely medical advice can have serious ramifications. We urge you to discuss any current health related problems you are experiencing with a health care professional immediately. 5. Limitation of liability and exclusion of warranty. THIS SITE IS PROVIDED AS IS, AND YOUR USE OF IT IS EXCLUSIVELY AT YOUR OWN RISK. LA LUNA SOL MAKES NO WARRANTIES, EXPRESS OR IMPLIED, ABOUT THE USE OF THIS SITE OR THE MATERIALS IN IT, AND DISCLAIMS ANY EXPRESS OR IMPLIED WARRANTY OF ACCURACY OR QUALITY, AND ANY IMPLIED WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT. LA LUNA SOL  ALSO EXPRESSLY DISCLAIMS ANY LIABILITY FOR ANY DAMAGE TO, OR VIRUSES THAT MAY INFECT, YOUR COMPUTER EQUIPMENT OR OTHER PROPERTY AS YOU ACCESS OR BROWSE THE SITE OR DOWNLOAD MATERIAL FROM IT. UNDER NO CIRCUMSTANCES SHALL LA LUNA SOL BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES, WHETHER IN AN ACTION IN CONTRACT OR TORT (INCLUDING NEGLIGENCE AND STRICT LIABILITY), RESULTING FROM ITS PERFORMANCE OR ANY FAILURE TO PERFORM UNDER THESE TERMS OF USE, INCLUDING, BUT NOT LIMITED TO, LOSS OF DATA, INABILITY TO ACCESS OR USE THE SITE, AND LOSS OF ANTICIPATED PROFITS OR BENEFITS, EVEN IF MLH HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. 6. Communications by you. Any communication or material you transmit to the site by electronic mail or otherwise, including data, questions, comments, suggestions, or the like, is, and may be treated as, non-confidential and non-proprietary. Anything you transmit or post becomes the property of La Luna SoL and may be used for any purpose, including, but not limited to, reproduction, disclosure, transmission, publication, broadcast, and posting. Furthermore, La Luna SoL is free to use any ideas, concepts, know-how, or techniques in any communication that you send to the site, for any purpose whatsoever, including, but not limited to, developing, manufacturing, and marketing products. We do not respond to any questions concerning specific medical conditions. If you transmit such information, while we will not intentionally release it or make it public, we cannot assure you that the information will be kept private. WE URGE YOU NOT TO SEND SUCH INFORMATION BY EMAIL. 7. Privacy. We refer you to our privacy statement for a complete discussion of how La Luna SoL utilizes information you communicate via our website. 8. Trademarks. All trademarks, service marks, and logos ("Trademarks") displayed and used in this site are the property of their respective owners. Nothing in this site should be construed as granting any right or license to use any Trademark without the written permission of its owner. 9. Content of linked sites. La Luna SoL has not reviewed other sites linked to its site, and is not responsible for their content. Accessing linked sites is at your own risk. 10. Export control. Software and other materials from this site may be subject to United States export control. The export control laws of the United States prohibit exporting certain technical data and software to certain territories. No software from this site may be downloaded or exported (1) into (or to a national or resident of) Cuba, Iraq, Libya, North Korea, Iran, Syria, or any other country to which the United States has embargoed goods; or (2) to anyone on the U.S. Treasury Department's list of specially designated nationals, or the U.S. Commerce Department's table of deny-orders. La Luna SoL does not authorize the downloading or exporting of any software or technical data from this site to any prohibited jurisdiction under the United States export laws. 11. Revisions. La Luna SoL reserves the right to modify and supplement these terms at any time, without prior notice, by posting the new terms on the site. You agree that your continued access and use of the site shall constitute your acceptance of the new terms. 12. Disputes. This agreement is governed by the laws of Pennsylvania, regardless of conflicts of laws. The [Discuss] or the federal district court of the Eastern District of Pennsylvania shall be the exclusive jurisdiction and venue for any claim between the parties, who consent to the jurisdiction and venue of those courts. 13. Intellectual property limitation of liability. La Luna SoL respects the intellectual property of others, and we ask visitors to our site to do the same. If you believe your work has been used in a way that constitutes copyright infringement, the following information in the form of a written notification (pursuant to 17 U.S.C. § 512(c)) must be provided to the designated agent of La Luna SoL: * Identification of the copyrighted work(s) that you claim has been infringed; * Identification of where the material that you claim to be infringing is located on the site; * A statement that you have a good faith belief that use of the disputed material is not authorized by the copyright owner, its agent, or the law, including the law of copyright fair use; * A statement that the information in the notification is accurate, and under penalty of perjury, that you are the owner of an exclusive copyright that is allegedly infringed or are authorized to act on the copyright owner’s behalf; * Your address, telephone number, and email address; * Your physical signature . Similarly, if you believe any of your trademarks or service marks has been infringed, or if you believe that your image has been used without your consent, please notify the designated agent of La Luna SoL. YOU ACCEPT THESE TERMS BY USING THIS WEBSITE.

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