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Have you ever worked with another Modern Mystery School or lineage of King Saloman practitioner?*
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By providing my signature below, I confirm that the information recorded above is complete, accurate, and honest to the best of my knowledge. I understand that energy healing therapies are not a replacement for medical or mental health treatment, and that the therapist may only perform treatments within his or her scope of practice as certified by the Modern Mystery School, and level of comfort. Anything said during this session shall not be regarded as medical advice, treatment, diagnosis, or prescription. I acknowledge that I am responsible for continuing any treatments if any prescribed by my psychologist, psychiatrist, or medical doctor including but not limited to therapy and medications. I understand that the therapist may refuse service at any time for any reason, and that clients may be referred to a medical professional if the therapist feels this is necessary. I consult Modern Mystery School practitioners for spiritual well being, teachings, and practices. I understand that I am attending the session or class of my own free will and choice, and I am free to leave for any reason if I feel uncomfortable. I understand that it is my responsibility to inform the therapist of any changes to my health profile and that the therapist will not be held liable for anything resulting from my failure to do so. I agree that I have been given sufficient opportunity to ask questions and make specific requests in order to make my treatment time as comfortable as possible. I have also read and will abide by all policies and client expectations that may be listed separately from this document. I understand that it is my choice to receive treatment and that I will not hold Margaret Dembinski, Love Life Activate or the Modern Mystery School liable for any changes to my health after the session or class. Although the tools adn teachings of the Modern Mystery School are powerful, I acknowledge that results vary and come as a result of dedicated practices and diligence on my part. With this signature (enter your name with date) I acknowledge I have read and understood the above statements and am in agreement. Signature:
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