As part of my session work with Sandi Radomski, Tom or Pam Altaffer, I will learn about a healing modality called Ask and Receive TM. A&R appears to have promising mental, spiritual, and physical health benefits but has yet to be fully researched by the Western academic, medical, and psychological communities. A&R is a relatively new healing approach and the extent of its effectiveness, as well as its risks and benefits, are not fully known. The prevailing belief is that A&R uses parts of one’s being (our unconscious, higher parts of ourselves, etc.) to create new solutions and pathways in our conscious mind and body in order to achieve what we want changed in our life. By submitting this document, I understand that A&R could be considered experimental and I agree to assume and accept full responsibility for any and all risks associated with using A&R as part of my participation in coaching sessions.
By participating in the coaching session, I understand that it is possible that emotional or physical sensations or additional unresolved memories may surface which could be perceived as negative side effects. Further, I understand it’s possible to experience some emotional distress and physical sensations related to prior life experiences. The clinical reports from energy therapies such as A&R show no additional side-effects when used appropriately. Emotions may continue to arise after the session and I understand I’m encouraged to discuss such emotions with my appropriate health care provider. In addition, I understand, previously vivid or traumatic memories may fade. This could adversely impact my ability to provide detailed legal testimony regarding a traumatic incident. I agree to take full responsibility for my self-care in the emotional, mental, physical, and spiritual dimensions of my life.
The information presented during my session, including learning about A&R, is provided only as general information and is not intended to represent that A&R is used to diagnose, treat, cure, or prevent any disease or psychological/mental health disorder. A&R is not a substitute for medical or psychological treatment. I understand that Sandi Radomski, Tom or Pam Altaffer do not recommend that I stop seeing any of my health care professionals or using prescribed medicine, if any, without consulting with the appropriate health care professional, even if after using A&R, or any other energy based technique, it appears or indicates such medicine or therapy is unnecessary.
Any stories or testimonials presented during my sessions do not constitute a warranty, guarantee, or prediction regarding the outcome of an individual using A&R during or after the session for any particular issue. Further, I understand that Sandi, Tom or Pam make no warranty, guarantee, or prediction regarding any outcome for me using A&R during or after the session for any particular issue. Sandi Radomski, Tom or Pam Altaffer accept no responsibility or liability whatsoever for the use or misuse of the information provided during the sessions. I understand that Sandi, Tom and Pam strongly advise that I seek professional advice as appropriate before making any health decisions.
While the practitioners (Sandi Radomski, Tom and Pam Altaffer), are all Licensed Clinical Social Workers (LCSWs), I understand that he or she is not providing psychotherapy but coaching sessions. I acknowledge that I have been given the opportunity by the Practitioner to ask questions regarding any aspect of this Agreement. By submitting this form (after filling in my name and the date), I acknowledge that I have carefully and completely read and fully understand all aspects of this Agreement and I agree to all of the terms and conditions stated herein. Further, I agree and understand that this Agreement is intended to be a complete unconditional release of liability and assumption of risk to the greatest extent permitted by law. This Agreement shall be binding upon me and my heirs, legal representative, and assigns.
I represent that I am an adult under the laws of the State of my residence and I have the right to enter into this Agreement. If I am a minor, I shall have my parent or legal guardian consent to and join in this Agreement by submitting this form (after filling in my name and the date).
Please indicate your acceptance and agreement by clicking the Summit box (after first including your name and the date) in the boxes below.
By entering my name below I am entering my digital signature indicating that I have read the above disclaimers and agree to each paragraph.