Consent + Disclosure Form

Consent + Disclosure Form

ALEXANDER TECHNIQUE USA LLC

Sydney Laurel Harris

This form gives you information about the Alexander Technique as practiced through the Alexander Technique USA LLC and seeks your consent to be professionally guided, including touch, as part of the Alexander Technique education.

 

  1. As per California law, you are hereby informed that the practitioner of the Alexander Technique provided through Alexander Technique USA LLC is not a state licensed therapist, nor is a physician or surgeon, nor will such practitioner ever discourage your contacting a licensed medical professional at your discretion.

  2. The Alexander Technique service provided through Alexander Technique USA LLC is not licensed by any public agency, and it is hereby understood that no guarantee or promises of cure have been, or will be, made.

  3. The practitioner of the Alexander Technique provided through Alexander Technique USA LLC is certified to teach the Alexander Technique by the American Society for the Alexander Technique, the national accrediting body of the Alexander Technique.

  4. Cancellations: appointment times will be reserved for the client. The client is thereby expected to reschedule such appointments at least 48 hours in advance should a cancellation be required, to avoid billing in full for the scheduled time.

  5. It is hereby understood that all information shared by client during scheduled appointment services provided by the Alexander Technique USA LLC are strictly confidential.

 

By entering your name below, you acknowledge that you have read this Disclosure and Consent form, that you fully understand its contents and that you voluntarily consent, of your own free will, to its provisions and to the Alexander Technique service provided through the Alexander Technique USA LLC.


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