- I will keep (and be on time for) all my scheduled appointments with the Vital-Side team.
- If I need to schedule or reschedule an appointment, I will give 24 hours’ notice. If I don’t give 24 hours’ notice before rescheduling, I am aware that there may be a late rescheduling fee. Vital-Side does not offer refunds for cancellations.
- I will keep up to date with any payments, and I will not call or attend an appointment unless I have paid the amount necessary for services provided in full before our scheduled appointment.
- I understand that Vital-Side is in no way a medical treatment program. Any results, information, or suggestions given will not be considered medical treatment in any way, and I agree that I will:
- Communicate with my existing medical practitioner before and while engaging in Vital-Side services and continue any existing treatments prescribed to me;
- Inform Vital-Side and my existing medical practitioners if my condition is exacerbated or worsened by any information provided by Vital-Side, seek emergency care as appropriate, and terminate Vital-Side services as necessary;
- Let Vital-Side know if there are conditions that may prevent me from excelling in the program;
- Disclose to Vital-Side any of my symptoms that could be harmful to myself or others; and
- Assume all risks associated with engaging in Vital-Side services and not hold Vital-Side liable for side effects of Vital-Side’s services.
- I am aware that Vital-Side is an experiential program. Information provided is for informational purposes only and represents the opinions formed by Vital-Side members based on experiences, the experience of others, and research of sources.
- I will do my best to be open-minded about all new information learned in the program.
- While there are no guaranteed results from using Vital-Side services, I understand that it is recommended that I commit a minimum of six months to healing my limbic system.
- I will not sell or distribute learned information, handouts, packets, or any other materials from Vital-Side to others. I understand that if I do, my participation in the program will be stopped, and Vital-Side reserves the right to seek all remedies under the law.
- I will treat the staff at Vital-Side and shared offices and any other members of group services or group forums respectfully. I understand that if I am disrespectful or disrupt others' care, my participation in the program will be terminated.
- I understand that any information I give to Vital-Side is voluntary information and that although Vital-Side will keep information shared in one-on-one sessions confidential, anything shared in group services will not be treated as confidential. Further, I understand that Vital-Side’s services do not fall under the Health Insurance Portability and Accountability Act (HIPAA).
Signature: _____________________________________ Date: ______________