Intake Form - EXCEL Weight Loss Solutions

Client Agreement and Disclaimer

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I understand that I will be working with Karen Donaldson in her capacity as an “energy healing” and mindset practitioner, using modalities such as EFT tapping, The Emotion, The Body Code, and more.

I take full responsibility for my own health and well-being while working with Karen Donaldson.

I understand that Karen is not a physician or other medical provider, psychotherapist, or psychologist and that she does not diagnose and/or treat diseases.

I understand that Karen is a registered and licensed dietitian. If I desire a consultation for medical nutrition therapy I may request to schedule that outside of this energy work.

I agree to my payment terms.

I agree to maintain the confidentiality of others if I am in a group setting.

I understand that the above is a summary of Karen's policies and I have been given the opportunity to review Karen's complete Privacy and Program Policies shown here - https://excelweightloss.com/policies/.

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CONTACT

EXCEL Weight Loss Solutions
Pocatello, ID 83204

Phone: +1 (208) 406-1084

Fax: +1 (208) 213-9403

E-mail:excelweightloss@gmail.com

Website:https://excelweightloss.com

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Client Agreement and Disclaimer

Client Agreement and Disclaimer

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