By purchasing a Consultation from Discussing Dissociation, I hereby certify and agree as follows:
I accept full responsibility for my mental health and voluntarily complete this Acknowledgment and Waiver of Liability.
I certify that I am seeking the consultation and services of Kathy Broady and Discussing Dissociation for mental health support, which I fully understand is not mental health treatment or a substitute for treatment.
I certify that with respect to any mental health or medical conditions or concerns I may have, I understand that Kathy Broady is not my primary therapist and I do not view her as my therapist.
I understand that Kathy Broady does not handle mental health emergencies and does not maintain hospital privileges. If I have mental health emergency I understand that I need to call 911 (or 000 in Australia) or go to the nearest emergency room.
I understand that email is not confidential, secure or 100 percent reliable.
I understand and agree that neither Kathy Broady nor Discussing Dissociation make any claims whatsoever, expressed or implied, regarding effects or outcomes of the analyses or support provided, and shall not be liable for same. I certify that I seek the advice and support of Kathy Broady and Discussing Dissociation solely in my personal capacity, and do not represent any governmental agency, law firm, attorney, or investigator. I am not involved in a lawsuit nor am I gathering information for a potential lawsuit.
I understand and agree on behalf of myself, my dependents, heirs, administrators, legal representatives, and assigns, to release and hold harmless Kathy Broady, Discussing Dissociation, and any and all associates, employees, agents and representatives thereof, from any and all liability for illness, injuries, or death, and for any losses or damages relating thereto, however occurring, in relation to my consultation with and/or treatment by Kathy Broady and/or Discussing Dissociation. Without limitation, I understand and agree that neither Kathy Broady, Discussing Dissociation, nor any associates, employees, agents or representatives thereof, is liable for any direct, indirect, consequential, or incidental damage, injury, death, loss, delay, or inconvenience of any kind which may be occasioned by reason of any act or omission, including, without limitation, any willful or negligent act or failure to act, or breach of contract.
My purchase of a Consultation from Discussing Dissociation indicates that I have carefully read and reviewed this Acknowledgment and Waiver of Liability, and I fully understand all of its terms and conditions; I recognize and accept all risks and limitations involved in seeking advice and support from Kathy Broady, Discussing Dissociation and associates, employees, agents and representatives thereof; I have not relied upon any other promises, agreements or representations by Kathy Broady, Discussing Dissociation, or any associates, employees, agents or representatives thereof concerning the support provided or the terms of this Acknowledgment and Waiver of Liability; and I execute and deliver this Acknowledgment and Waiver of Liability freely and voluntarily and without duress or coercion and with full knowledge of the representations contained herein and the rights relinquished, surrendered, released and discharged hereunder.
UNDERSTOOD, ACCEPTED, AND AGREED
By continuing today with the purchase process from Discussing Dissociation, I am acknowledging that I understand, accept and agree with the above.