Consent, Disclosure and Disclaimer Form
I consent to participating in the Eden Retreat Center (ERC) ___________________________. I understand that my care as a client at ERC is directed by trained professionals, including (but not limited to) integrative physicians, acupuncturists, medical doctors, massage therapists, nutritionists, herbalist and naturopaths. I consent to services rendered and provided to me by the attending health care providers and trained professionals participating or consulting about my care. I understand that all of the therapists are highly trained in their selected fields but may not have licensing in the state or country that I receive my treatment in.
I understand that my retreat is not intended as a diagnosis, prescription or cure for any condition, mental or physical, real or imaginary.
I commit to full participation in my care. I will keep an open mind and heart and participate in as many of the treatments as possible. If I am ever uncomfortable I understand that I have the right to pass on any therapy, but I agree to be open to trying therapies that may be outside my comfort zone at least once. I will take responsibility for myself and my health. I will respect the confidentiality of others and understand that my confidentiality will be respected as well. I know these treatments will challenge me physically, spiritually and emotionally and I am ready for that challenge.
I understand that this is a merit based program and I will be held accountable for my participation in the program. If it is determined that I am not fully participating in my retreat I understand that I may be switched to a less intense program or asked to leave the facility. I further acknowledge that in either event I agree to pay the full amount for my retreat and will not be refunded for a change in programs.
I recognize that there are certain inherent risks associated with the above described activities and I assume full responsibility for personal injury to myself and (if applicable) my family members and further release and discharge Eden Retreat Center, it’s health care practitioners for injury, loss or damage arising out of my or my family’s treatment(‘s), weather caused by fault of myself, my family, Eden Retreat Center or other third parties.
I agree to indemnify and defend Eden Retreat Center and its health care providers against all claims, causes of action, damages, judgements, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family’s use of or presence upon the facility. I agree to pay full damages to the center caused by my or my family’s negligent, reckless or willful actions.
Under the ninth amendment of the Constitution of the United States of America, I retain the right to freedom of choice in health care. This includes the right to choose my diet, and to obtain, purchase and use any therapy, regimen, modality, remedy or product recommended by the therapist, doctor and any practitioner of my choice.
I have read this document and understand it. I further understand that by signing this release, I voluntarily surrender certain legal rights.