IMPORTANT INFORMATION

Disclaimer & Client Acknowledgement

Please review each statement and submit the electronic acknowledgement before receiving clearing work.

Thank you. Your acknowledgement has been recorded.

Please read carefully. This form records your acknowledgement electronically so there is no need to exchange physical paperwork.

Client Disclaimer Form

Complete the fields below, review all statements, and type your full name as your electronic signature.

Full Name (please print) Email Address Phone Number Date

By signing this form, I agree that I am aware that Rosemarie Lanchester, Owner of Everything You Wish For is not a Traditional Medical Professional.

The tools and Techniques she teaches are of a Holistic nature and are not meant to replace any medical advice by a qualified physician. Every Client is responsible for their own healing journey.

Before modifying any care plan, Rosemarie strongly advises you consult with your doctor for further recommendations. I recognize that I should never cease taking any prescribed medication without consulting my personal physician first.

Electronic Signature — Type Your Full Name I have read the statements above, understand them, and intend the typed name above to serve as my electronic signature and acknowledgement.

For recordkeeping, this submission stores the information entered above along with the submission date/time and basic connection information in a server-side text record.