Radiance Wellness Co.
Client Informed Consent and Liability Waiver
Springfield, Missouri
Radiance Wellness Co.
1722 S Glenstone Ave Suite D, Springfield, MO 65804
hello@radiancewellnessco.com
radiancewellnessco.com
I understand that Radiance Wellness Co. offers complementary and alternative wellness services including Hypnosis, Biofield Tuning, Reiki, Emotion Code, BrainTap, and Bemer PEMF (Pulsed Electromagnetic Field therapy). These are non-medical, holistic modalities intended to support relaxation, stress reduction, emotional balance, and overall well-being. They are not a substitute for medical diagnosis, treatment, or care provided by licensed healthcare professionals.
I am voluntarily seeking these services for my own personal growth and wellness.
Informed Consent
I acknowledge and understand the following for each modality:
- Hypnosis / BrainTap: Involves guided relaxation and focused attention. I understand it is generally safe but may bring up emotions or memories. It is not suitable for individuals with certain psychiatric conditions (e.g., psychosis, severe dissociation) without medical clearance.
- Reiki / Biofield Tuning / Emotion Code:Energy-based practices using light touch or no touch, sound tools (tuning forks), or magnetic fields to support the body's natural healing. These may cause temporary sensations (warmth, tingling, emotional release, fatigue).
- Bemer PEMF: Uses pulsed electromagnetic fields to support circulation and cellular function. Contraindications may include pacemakers, pregnancy, epilepsy, or certain implants—I confirm I have disclosed any relevant conditions.
I have disclosed (or will disclose prior to each session) all relevant health information, including medications, medical conditions, pregnancy, implants/devices, mental health history, or recent surgeries. I understand the practitioner may refuse service if safety is a concern.
I understand that results vary by individual and are not guaranteed. No claims are made to cure, treat, diagnose, or prevent any disease or condition.
Assumption of Risks and Liability Waiver
I understand that these services carry potential risks, including but not limited to: temporary emotional discomfort, fatigue, dizziness, headaches, muscle soreness, or rare allergic reactions to materials. I assume full responsibility for any such outcomes.
Hypnosis / BrainTap: Involves guided relaxation and focused attention (including audiovisual elements in BrainTap). Contraindications for BrainTap include epilepsy and extreme light sensitivity.
Bemer PEMF — Absolute Contraindications (Do not use)
- Immunosuppressive therapy following organ, bone marrow, or stem cell transplantation
- Diagnosed Deep Vein Thrombosis (DVT)
- Active medical implants that deliver medication (e.g., insulin pumps or other medication pumps)
Relative Contraindication (Physician clearance required)
- Active stimulating medical implants (pacemakers, defibrillators, brain stimulators, muscle stimulators)
Additional Cautions (Consult a physician before use)
- Pregnancy
- Fever of unknown origin or active infectious disease
- Severe cardiac rhythm disorders
- Uncontrolled seizure disorders (e.g., epilepsy)
- Serious conditions requiring ongoing medical treatment (including tumors)
- Long-term use of blood thinners (e.g., Warfarin/Coumadin), beta-blockers, or corticosteroids
Note: BEMER is not intended for use on the head/face or by individuals under 18. Always disclose implants, medications, and medical history.
Additional Agreements
- I consent to sessions being conducted in-person or, if applicable, remotely (e.g., distance Reiki or BrainTap).
- I authorize audio recordings or session notes for my records only (optional; initial if yes: ______).
- I understand sessions are confidential, except as required by law (e.g., imminent harm) or for business records.
- I agree to arrive on time, follow practitioner guidance, and inform staff of any discomfort during a session.
- Photo/Media Release (optional): I grant permission for Radiance Wellness Co. to use my likeness/testimonials for marketing (initial if yes: ______; no if left blank).
- Payment is due at time of service. No refunds for completed sessions.
Client Acknowledgment
By signing below, I confirm that:
- I have read and fully understand this document.
- I have had the opportunity to ask questions and have received satisfactory answers.
- I am at least 18 years old (or have parental/guardian consent).
- I am participating voluntarily and accept all terms.
Client
Parent / Guardian (if applicable)
Facilitator / Witness