Pet Intake and Release Form
Please read, and sign, this disclaimer and send to me BEFORE I begin my work with you. Just fill out and snap a picture and send to my email at firstname.lastname@example.org . I freely acknowledge that I am fully aware that Marcella Regal is not a medical doctor or any other kind of medical practitioner and she has not represented herself in any way as possessing any medical expertise or medical training whatsoever and she has not prescribed, diagnosed, treated or recommend any particular treatment, medication, or substance for me in respect of my injury, ailment, or disease that I may possess. I have not been cajoled, coerced, threatened, or persuaded by Marcella Regal to undergo or partake in any particular treatment, medication, or substance – and that I freely acknowledge that any unorthodox or unusual treatment or medication or substance that I may utilize is done with my full awareness and acknowledgement that it is of my own free will. I, the undersigned, for myself, my heirs, hereby release and forever discharge Marcella Regal, from any and all actions, causes of action, claims and demands for or by reason of any damage, loss or injury, to person and property which heretofore has been or hereafter may be sustained in consequence of attending a workshop, or taking of any medication, substance, or treatment which I may use or consume in any respect of and for any attempts by myself or anyone on my behalf to cause temporary or permanent relief from the symptoms of any injury, ailment, or disease with which I have been or will be diagnosed. I have read and understood that Marcella Regal’s fees are to be prepaid before my appointment is scheduled and that the fees are non-refundable. If I need to reschedule my appointment, I will not be entitled to a refund unless I have provided 24 hours notice. If I miss my appointment I will not be entitled to a refund.