INFORMED CONSENT AND LIABILITY WAIVER FORM for

“Sharada Resonance Medicine”

I acknowledge that I have been fully informed about the nature of Sharada Resonance Medicine Treatments

TREATMENT DESCRIPTION AND SCOPE

‘Sharada Resonance Medicine’ may include herbal formulas, dietary recommendations, lifestyle counseling, and manual touch based therapies.

These treatments are complementary and integrative health practices and are not a replacement for biomedical diagnosis, conventional medical treatment, or emergency care

ACKNOWLEDGMENT OF INTEGRATIVE HEALTH PRACTICE

I acknowledge and understand that:

Integrative health professionals, treatments, and advisements are undertaken at my own liability and do not constitute a replacement for biomedical diagnosis and treatment by licensed medical physicians.

I have the right to refuse any treatment at any time and may stop treatment if I experience discomfort

LIABILITY WAIVER AND RELEASE

In consideration of receiving integrative health treatments, I hereby release, waive, discharge, and covenant not to sue the practitioner, their practice, employees, agents, or affiliates (collectively "Sharada Resonance Medicine") from any and all liability, claims, demands, or causes of action arising from any loss, damage, injury, or death that may be sustained by me, or to any property belonging to me, while receiving SRM treatments.

This waiver includes but is not limited to risks from procedures, herbal remedies, or touch based therapies. I voluntarily assume full responsibility for any risks, known or unknown, associated with these treatments.

CONFIDENTIALITY AND HIPAA ACKNOWLEDGMENT

I understand my health information is protected under HIPAA regulations. Sharada Holistic will maintain confidentiality except as required by law or with your written authorization.

I have read, understand, and voluntarily accept the information above. I have had the opportunity to ask questions and receive satisfactory answers.

Sharada Resonance Medicine 2026. www.sharadaholistic.com

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