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I agree and consent to the services & procedures offered by Seamus Robertson, Holistic Therapist. I understand that the services & procedures included under the umbrella of Holistic Therapy include techniques & procedures from modalities such as: Shiatsu Therapy, Tui Na Massage, Cranio-Sacral Therapy, Cupping, Qi-Gong, Reiki, Lymphatic Drainage Massage, Active Release, Myo-fascial release, Orthopaedic Assessments, Rebalancing, Polarity Therapy, Hakomi, & Bodytalk. I understand and agree to the nature of these services and the techniques involved in them. I understand that if I have any questions about this information & the above consented services & procedures, I must ask Mr. Robertson or educate myself otherwise. I understand that any information shared during any treatment, health consultation, and coaching sessions is held in strict confidence and that all information shared is not in any way shape or form medical advice. I understand that I must consult with my Naturopathic Doctor, TCMD, or Family Doctor before proceeding with any personal regiments or procedures (ie. diets, cleanses, supplementation, herbs, etc.) pertaining to any of the information shared by Mr. Robertson. I understand that I am free to withdraw my consent, in writing, at any time. I also agree to pay full treatment value for any future missed appointments or when less than 48 hours notice is given before any appointment cancellation or schedule changes. I hereby release Mr. Robertson from any and all liability that may occur in connection with my receiving and/or my lack of understanding of the above aforementioned services & procedures.


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