Consent Form

I understand that Alexandra Rose does not claim to cure any illness, disease physical or mental health issues with any alternative therapies.

•  I take full responsibility for my health and wellbeing and accept that any advice or therapy I receive from Alexandra Rose is complementary and not a substitute for professional medical treatment. I understand that these therapies and procedures do not diagnose disease.

•  I understand that Shiatsu and Craniosacral Therapy are touch-based therapies. I give permission for my body to be touched by Alexandra Rose. I will inform her if there are any areas of my body I do not wish to be touched.

•  I understand that I must inform Alexandra Rose fully of any existing medical or mental health conditions.

•  I understand that if Alexandra Rose offers emotional coaching techniques, these are not a replacement for counselling, psychotherapy, or psychiatric care. I will continue with any treatments or medications prescribed by my mental health professionals. If any work during the session triggers pre-existing mental health issues, I will consult my mental health provider.

•  I understand that I must continue all medications and treatments prescribed by my doctor unless advised otherwise by the prescribing doctor.

•  I understand that I must disclose any history of anaphylaxis (severe allergic reactions) before treatment begins, so every effort can be made to avoid direct contact with allergens and to ensure my safety.

•  I understand that my clinic notes, and personal data will be stored securely and retained for 7 years, after which they will be securely disposed of. I have the right to access my notes at any time.

I have read the above statements and have had the opportunity to consider the information and to ask questions. By signing below, I agree to all the terms and conditions and take full responsibility for accepting the sessions and outcome.