I consent to treatment for myself or my minor child, and understand that the services provided by the practitioner Nikki Llewellyn are intended to enhance relaxation, and increase communication and healing within my body. I understand that these services are not a substitute for medical treatment or medications. I am aware that diagnosis is not given, and medication is not prescribed. This consent form applies to all services provided by the practitioner, as listed on The Phoenix Palace website.*

I agree to continue to have regular medical check-ups as part of my overall health care plan. I understand that I may experience ‘healing reactions’ during the 24 to 48 hours following the services provided. I understand that any information exchanged during any session is educational in nature and is to be used at my own discretion. *

I also understand that any information imparted during these sessions is strictly confidential in nature and will not be shared with anyone without my written permission, except in the event of imminent harm to myself or anyone else. *

I give the practitioner consent to use my case history and results for research and training purposes within The Phoenix Palace, without using my name or identifying details. I understand my information will not be shared with or used by any third party, but the results (statistical data) may be shared.

I understand that only the practitioner Nikki Llewellyn will have access to information in my file to enhance my treatments. I understand that by providing this informed consent I am assuming full responsibility for my treatments and I hold harmless both the practitioner Nikki Llewellyn and The Phoenix Palace. I agree to the terms and conditions set out by this consent form and certify that the above information is true and correct.*