Pet-Loss Support Questionnaire
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Acknowledgement and Waiver of Liability
I hereby certify and agree as follows:
I accept full responsibility for my family’s mental health and voluntarily complete this Acknowledgement and Waiver of Liability.
I certify that I am seeking the consultation and coaching services of Jessica Mockett, a holistic pet-loss grief coach for holistic health and/or therapies, which I fully understand are not medical diagnoses or treatments or substitutes for medical diagnoses or treatments.
I certify that with respect to any medical conditions or concerns I or my family has, I have been advised to consult with my doctor or therapist, and understand that Jessica Mockett is neither a medical doctor or licensed therapist, and I do not view her as such. Her practice specializes in a natural approach to supportive grief healing, which could include, but not limited to, essential oils, art and music, light therapy, and energy therapies. I understand that Jessica Mockett does not handle medical emergencies.
In seeking to become a client of Jessica Mockett, I understand I am seeking analyses and/or therapies that may not be FDA registered or approved and may not be offered by practicing therapists and which some may consider experimental. I understand that if Jessica Mockett makes any suggestions regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, essential oils, or any compounds or any other external remedy of any kind, that I or my family may use or ingest, I do such at my own risk, with the recommendation here to the advice of a qualified holistic doctor before using any remedy suggested.
I understand and agree that Jessica Mockett makes no guarantees whatsoever, expressed or implied, regarding effects or outcomes of the analyses or therapies provided and shall not be liable for the same. I certify that I seek the advice and therapeutic treatments of Jessica Mockett solely in my personal capacity.
I accept that while Jessica Mockett will keep my sessions and personal information confidential, there is not an official or legal confidentiality between a pet behavioral professional/holistic healer and client as there is between a medical doctor or a lawyer and their patients/clients. Should my client records be subpoenaed, or otherwise required by law, Jessica Mockett must comply. Also, I understand that should we have online sessions, email correspondence, phone calls, or text message exchanges that these forms of communication are not secured, nor encrypted. While Jessica will never openly share my name with associated sessions and results, she may utilize examples or outcomes from my sessions as case study examples in her writings or work in an anonymous capacity, unless she otherwise seeks written permission to use my personal identity or pet’s identity in her writings or works.
I understand and agree on behalf or myself, my dependents, heirs, administrators, legal representatives, and assignees, to release and hold harmless Jessica Mockett and any and all associates, employees, agents, and representatives thereof, from any and all liability for any negative outcome, however occurring, in relation to my consultation with and/or therapies by Jessica Mockett and The Emotion Code, The Body Code, The Belief Code, or Discover Healing or any other energy, alternative, or spiritual therapies.
By checking the box I indicate that I have carefully read and reviewed this Acknowledgement and Waiver of Liability, and I fully understand all of its terms and conditions; I recognize and accept all risks and limitations involved in seeking advice and therapeutic treatments from Jessica Mockett; I have not relied upon any other promises, agreements or representations by Jessica Mockett, or any associates, employees, agents or representatives, thereof concerning, the treatment provided or the terms of this Acknowledgement and Waiver of Liability; and I execute and deliver this Acknowledgment and Waiver of Liability freely and voluntarily and without duress or coercion and with full knowledge of the representations contained herein.