DISCLAIMER

• The information I have provided is correct and accurate to the best of my knowledge. 

• I understand that holistic therapy results vary from person to person and the outcome cannot be guaranteed.

• I agree that I will NOT stop taking any prescribed medication from my healthcare provider unless they specifically advise me to do so.

• I accept responsibility for me receiving holistic therapies from Anastasia Borta.

• Anastastasia is not responsible for any costs that may be incurred as a result of requiring medical attention as a result of any issues that arise from our work together.

• I understand that she is qualified and insured to provide these services

• I may request a copy of this form if I wish.