Understanding Energy Healing: Important Waiver Information

It is important to be very clear that energy healing, a Rising Star, Prema Agni, Prema Birthing and wellness classes and coaching are NOT replacements for medical care, psychotherapy, or professional counselling. Practitioners do not diagnose conditions, perform medical treatments, prescribe substances, or interfere with any treatment from a licensed medical professional.

Please fill out the liability waiver form and e-sign prior to your appointment.

Informed Consent and Liability Waiver & Release

The undersigned client (“Client”), in order to induce Louise Johns (“Facilitator”) to perform Rising Star Healing Modalities, Prema Agni Healing Modalities or Prema Birthing Healing Modalities (“Healing Modalities”), agrees as follows:

Energy healing is a prayer and no results have been promised or guaranteed by the Facilitator;
Client will follow all instructions given to the Client by licensed medical practitioners and has not been instructed by the Facilitator to ignore such instructions or discontinue any medication or treatment prescribed to Client by any medical practitioner;
Client will indemnify and hold Born Free Now, LP, d/b/a SQ Worldwide (“SQ”), any affiliate thereof, Derek O’Neill and their agents, officers, directors and members free from any liability claimed by Client or others on the Client’s behalf;
Client understands that any Healing Modality performed by the Facilitator may or may not be effective for the Client and lack of results is not an indication of any wrongdoing by the Facilitator;
Client is under no duress, coercion or pressure to submit to the Healing Modalities.
Client agrees to make good faith, reasonable efforts to follow instructions provided by the Facilitator during and after a healing session.
Client shall not hold Facilitator liable for any injury to Client during the healing session, except if caused by the gross negligence or willful misconduct of the Facilitator and shall not hold SQ, any affiliate thereof and their agents, officers, directors and members or Derek O’Neill liable for any injury to Client during the healing session.
This waiver shall be governed by, and shall be construed in accordance with, the laws of the State of New York without giving effect to the conflict of laws principles thereof. Any lawsuit, action or proceeding arising out of or relating to this waiver may be instituted in any federal or state court in the city of New York, county of New York and Client waives any objections which he or she may now or hereafter have thereto, and hereby irrevocably submits to the jurisdiction of any such court in any suit, action or proceeding.
Electronically delivered copies of this executed waiver or signature page to this waiver shall be as effective as an original thereof.

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By clicking “I Agree’ below, you agree that you have read and agree with the liability waiver and informed consent and release document and that the information you provided is accurate. You furthermore agree that your submission of this form, via the ‘I Agree’ button shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this document.