1. I understand that energy healing, including DNA, Matrix, UpLevel, The Body Code,The Emotion Code, and other energy healing modalities that may be used by Activate Wellness | The DNA Guy practitioner(s) in sessions and programs, (hereinafter called “these methods”), seek to identify and eliminate underlying imbalances by releasing energetic imbalances such as limiting beliefs and stuck emotional energy in the areas of energy, circuitry, pathogens, structure, toxicity, and nutrition. These methods of energy healing promote harmony and balance within, relieving stress and supporting the body’s natural ability to heal. Energy healing such as these methods is widely recognized as a valuable and effective complement to conventional medical care.

2. I understand that releasing trapped emotions, or the correction of any other energetic imbalance using these methods as practiced by Activate Wellness | The DNA Guy practitioner(s) in sessions and programs, is not a substitute for medical or psychological care. This information is not intended as medical advice, and should not be used for medical diagnosis or treatment. Information received is not intended to create any physician-patient relationship, nor should it be considered a replacement for consultation with a healthcare provider, nor is it meant to replace any medical treatments as ordered by any physicians nor any other medical care you have been advised to seek by them. I further understand that these methods are not a replacement for any professional psycho-therapeutic or counseling sessions in the treatment of any mental health issues or disorders, and that my practitioner(s) is not a medical doctor, nutritionist, or psychologist.

3. I understand that if my practitioner makes any suggestions regarding supplementation of any kind, such as vitamins, minerals, herbal preparations, or any compounds or any other external remedy of any kind, that I use or ingest any such at my own risk, with the recommendation that I seek the advice of a physician before using any remedy suggested by my practitioner.

4. I understand that in approximately 20% of sessions, the release of trapped emotion(s) or other energy(s) may result in “processing,” where echoes of the emotion(s) or other energy(s) released may manifest in temporary physical or emotional discomfort, and that this “processing” appears to be a normal part of regaining energetic balance.

5. I understand that my practitioner makes no claims as to healing or recovery from any illness I may have now, nor the prevention of any illness I may have in the future, and that no guarantee is made towards validity.  I further understand that the use of any information I receive is at my own risk.

6. I understand that if I have health or well-being concerns, I am recommended to seek advice from an appropriate medical practitioner before making any decisions about my health, and that this information is offered as an educational service and is not meant to replace any medical treatment.

7. I understand that if I have health concerns, I am recommended to seek advice from an appropirate medical pracitioner before making any decisions about my health, and that this information is offered as an educational service and is not meant to replace any medical treatment.

8. I understand that these sessions, and/or group healing sessions are confidential, and that any personal information would be used anonymously for educational and research purposes only, subject to any exceptions governed by laws of the State of Hawai’i, or of Federal laws and regulations, and if used for these purposes that identifying personal information such as my last name and city will be deleted to maintain my privacy, unless required by law.

9. I understand that I and other participants in the Activate Wellness | DNA Guy program may choose to share personal details of our lives, and I agree to hold these communications from other participants confidential, whether they happen in the Activate Wellness | The DNA Guy program Facebook group, in emails, on group calls or in any other method of communication associated with the Activate Wellness | The DNA Guy programs. I agree that if any information is shared outside the group by a participant, I hold Glenn Forman and Forman Design Group, LLC as having no legal liability for that sharing of information.

10. I agree to pay the agreed upon fee for each session either before or at the time of the session, and understand that fees may change over time and that I will always be told the fee before particpating in any session.

11. I confirm that I have received, reviewed, and signed the Client’s Bill of Rights according to the requirements of the State of Hawaii.

12. I confirm I have received the HIPAA Notice of Privacy Practices sent to me separately.

13. If any term of this Agreement is to any extent invalid, illegal, or incapable of being enforced, such term shall be excluded to the extent of such invalidity, illegality, or unenforceability; all other terms in this agreement shall remain in full force and effect.

14. This Agreement and any action related thereto, as well as any disagreement about the Agreement or services provided under it, will be governed by the laws of the State of Hawai’i.

15. I understand that by signing this form, I fully consent to participating in the energy healing work in the DNA, Matrix, UpLevel, The Body Code, The Emotion Code or other energy healing session(s) with each Activate Wellness | The DNA Guy practioner with whom I choose to schedule an appointment(s), including if I choose, group energy healing session(s) as part of my full participation.