Six Alchemy

Client Consent Form

Date:

First name + Last name

consent to treatment for myself and understand that the services provided by the Practitioner BECKY BROWER @SIX ALCHEMY is intended to enhance relaxation and increase communication within my body.

I understand that these services are not a substitute for medical treatment nor medications. I am aware that the Practitioner does not diagnose and that medication is not prescribed. Any supplements or other external aids mentioned during the session are to be investigated further by me with a trusted medical authority before use.

I understand that after all healing work, I may experience ‘healing reactions’ during the 24 to 48 hours following the services provided.

I understand that any information exchanged during any session is educational in nature and is to be used at my own discretion.

I also understand that any information imparted during sessions is strictly confidential in nature and will not be shared with anyone without my written permission.

I understand that only the practitioner BECKY BROWER @SIX ALCHEMY will have access to information in my electronic file to enhance my healing.

I understand that by providing this informed consent I am assuming full responsibility for my services and I hold harmless both the Practitioner, BECKY BROWER and SIX ALCHEMY where the services are provided.

I agree to the terms and conditions set out by this consent form and certify that the above information is true and correct.

I have read, understood and agree to the above terms.

Yes, subscribe me to the Six Alchemy newsletter.

I do not wish to be added to the Six Alchemy newsletter.

I understand that by printing my name in the box below that I am agreeing to treatment outlined in the Client Consent Form above and providing my consent.

Six Alchemy

Privacy Policy + GDPR

All Six Alchemy Coaching + Wellbeing Sessions are dependant on the investigation into the health capacity of a client, and collection of sensitive information is necessary for the work to proceed.

This data is treated sensitively and is securely stored electronically.

Online data may include the recording and transfer of recorded sessions,

only at the clients request, and with the clients prior express permission.

Data such as telephone numbers, email addresses and appointment information will be stored securely online and on a password protected computer and phone only accessible by the Practitioner.

Email addresses will not be used for marketing purposes unless the client has given their express permission.

Client information is retained for a period of eight years in line with insurance policy best practice.

www.sixalchemy.com

Six Alchemy

Client Consent Form

Six Alchemy

Privacy Policy + GDPR

Reiki + Holistic Wellness