Group Session Consent Form Name * First Name Last Name Email * Group Attending * Please add the date, time and location of the group you are registering for Message Group Participant Consent Form By checking the drop down agreement below and entering your name above, you attest to reading and understanding the information provided and agree to the Informed Consent for sound sessions. • Any suggestion made by Soul-cial Circles, Connie Iezzi, will be to assist my body’s natural ability to achieve a balanced state, to the extent that my body will allow • These sessions are not meant to replace treatment by established medical practices and can complement them. • There are no guarantees as to the results of the session • Soul-cial Circles, Connie Iezzi, is not a licensed physician and is not acting in a social work or therapist capacity, and will neither diagnose nor prescribe any condition nor does she make any specific claims regarding results from the sessions that I receive. • Nothing in the work Soul-cial Circles or Connie Iezzi, does is considered the practice of medicine. • I agree to consult with my physician and get approval to attend energy sessions if I have metal in my body, suffered concussions, have a pacemaker, use an insulin pump, and the like. • I agree to raise any questions or concerns about anything I do not understand and I take full responsibility for my own health care. • Give consent to Soul-cial Circles, Connie Iezzi, to conduct a session to provide relaxation and balance my energy system. Consent * By clicking below I acknowledge receipt of and agree to the above conditions and give consent to receive a sound session. I give my informed consent Thank you!
