Consent for Services
By submitting this form, I acknowledge and agree to the following:
1. I understand that all forms of energy work (including but not limited to Trauma Release, Subconscious Reprogramming, Offensive Energy Release, B.E.S.T., Whole Body Balance, Bio-Resonance Healing and Usui/Arcturian Reiki), as practiced by Dr. Eve Gabrielyan, seeks to identify and eliminate underlying imbalances. This is done by releasing energetic imbalances in the areas of one’s energy body, physical body, circuitry, pathogens, structure, toxicity, and nutrition. These methods of energy healing promote harmony and balance within, relieving stress and supporting the body’s natural ability to heal.
2. I understand that releasing trapped emotions/energies, or the correction of the other energetic imbalance using these methods as practiced by Dr. Eve Gabrielyan, is not a substitute for medical care. This information is not intended as medical advice and should not be used for medical diagnosis or treatment. Information received is not intended to create any physician-patient relationship, nor should it be considered a replacement for consultation with a healthcare provider, nor is it meant to replace any medical treatments as ordered by any physicians nor any other medical care I have been advised to seek by them. I further understand that these methods are not a replacement for any professional psycho-therapeutic or counseling sessions in the treatment of any mental health issues or disorders.
3. I understand that if Dr. Eve Gabrielyan makes any suggestions regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, or any compounds or any other external remedy of any kind, that I use or ingest at my own risk, with the recommendation that I seek the advice of a physician before using any remedy suggested by my practitioner.
4. I understand that in approximately 20% of sessions, the release of trauma, or other energies may result in “processing,” where echoes of the emotions or other energies release may manifest in temporary physical or emotional discomfort, and that this “processing” appears to be a normal part of regaining energetic balance.
5. I understand that Dr. Eve Gabrielyan makes no claims as to healing or recovery from any illness I may have now, nor the prevention of any illness I may have in the future, and that no guarantee is made towards validity. I further understand that the use of any information I receive is at my own risk.
6. I understand that if I have health concerns, I am recommended to seek advice from an appropriate medical practitioner before making any decisions about my health, and that this information is offered as a service and is not meant to replace any medical treatment.
7. I understand that these sessions are confidential, and that any personal information would be used anonymously for educational and research purposes only, subject to any exceptions governed by laws of the State of California, or of Federal laws and regulations, and that identifying personal information such as my name and city will be deleted to maintain my privacy, unless required by law.
8. I understand that while all communications are treated with care and kept confidential, email and text are not guaranteed to be secure or HIPAA-compliant. I acknowledge this and accept any privacy risks involved in choosing to communicate through these methods.
I give permission to receive session reminders, scheduling information, follow-up notes, and general guidance via email or text, understanding that these communications may include details about my sessions or recommendations shared by Dr. Eve Gabrielyan.
9. I understand that this form is not encrypted or HIPAA-compliant. I agree not to submit any personal health information through this form and accept any privacy risks associated with using this method of communication.
10. I understand that by signing this form, I fully consent to participating in sessions with Dr. Eve Gabrielyan. I confirm that I am 18 years of age or older and have the legal capacity to enter into this agreement.
Before you submit:
By completing this form, you acknowledge that you have read and agree to the Privacy Policy, Terms of Use, and Disclaimer. It is your responsibility to review these policies before submitting personal information or engaging in services.