Consent + Disclosure Form

Sydney Laurel Harris

Alexander Technique

Consent and Disclosure Form

This form gives you information about Sydney Laurel Harris and the Alexander Technique and seeks your consent for you to be guided and touched as part of the Alexander Technique.

 

1. Under California law, you need to know that Sydney Laurel Harris is not a state licensed therapist, physician or surgeon. Sydney Laurel Harris does not and will not discourage you from contacting a licensed medical doctor.

2. The Alexander Technique lessons are not licensed by any public agency. Sydney Laurel Harris is certified to teach the Alexander Technique by the American Society for the Alexander Technique, the national accrediting body. No guarantee or promises of cures have or will be made.

3. I understand that any information that I share with Sydney Laurel Harris during a session will be kept confidential.

4. Cancellations: Your appointment time has been set aside for you. Therefore I would appreciate your letting me know 48 hours in advance in case you have to reschedule your appointment. If less than 48 hours’ notice is given and you do not reschedule your appointment, you will be charged the full fee.

 

By entering my name below, I acknowledge that I have read this Disclosure and Consent Form. I understand the contents of this form and voluntarily choose of my own free will to participate in the Alexander Technique lessons as described.

Additionally, please be sure to print and fill out the CLIENT INFORMATION sheet. Thank you!