Please click this link to download PDF version(75 kb) of the agreement below, print, sign and carry to your first appointment with us. Else email the signed, scanned copy to

On this _________ day of _______________, I ________________________ of _____________________________ hereby ACKNOWLEDGE AND AGREE the following in connection with the treatment/therapies received from the Healing Boutique (HB): 


  • I have been informed and I understand that HB’s treatments are not intended to replace allopathic/Western Medicine, homeopathic, naturalistic or any other conventional, unconventional and/or other treatment undertaken. The HB provides alternative therapies and treatments that compliment and enhance other therapies and treatments them.
  • The HB does not provide conventional medical or psychological treatment. Any diagnosis provided by the HB is done from an energetic or otherwise alternative perspective. The HB does not prescribe any medication or interfere with any treatment prescribed by a licensed medical professional.
  • The HB strongly recommends that its clients consult a duly qualified and licensed health care professional for any physical and/or psychological ailments who will be held medically responsible for the client’s recovery and continue with that treatment while being assisted by the HB.
  • I, _____________________ agree that is solely my responsibility to consult certified medical professionals to treat all my physical and other ailments.
  • The HB accepts no responsibility whatsoever for any act or omission on the part of their clients, their medical professional or other therapists.


2.1 The HB accepts no responsibility and makes no guarantee whatsoever for my recovery and for the permanence and extent my recovery.

2.2 I have understood that the HB’s method of healing requires my involvement and I agree to follow their instructions provided and to update them as per their instructions of my progress.

2.3 The HB does not accept any responsibility for any effects, acts, omissions or expectations arising in relation to any of its treatments, therapies and techniques. Should I feel any discomfort or uneasiness or a craving or desire for any addiction I seek help from it is my responsibility to contact them and to avail their assistance which has been offered 24/7.

3.            RIGHT OF REFUSAL 

3.1 the HB is not in any way whatsoever obligated to accept every request made by me. I understand and acknowledge that they reserve the right to refuse any request I make regarding my treatment.

3.2 I also understand that the HB may terminate their services to me if I fail to cooperate with them, perform any activity or act required to facilitate my recovery and/or interact with them appropriately and regularly with regards to my treatment.

3.3The HB and all the organizations associated with it accept no liability of any nature whatsoever as a result of any services they or any of their associated organisations provides.

3.4 The HB also clarifies that it is not responsible for any acts, omissions or anything whatsoever for any recommendations it or its affiliates make with regards to any other professionals, the services of any other professional and/or organization, any reading materials etc.

4.       My OBLIGATIONS:

4.1 I acknowledge that I have and will continue to disclose all information about my physical and mental health to the HB.

4.2 I am solely responsible to contact and update the HB in writing of any change in the condition of his or her physical and mental condition for the duration of my treatment with them. I am aware that especially applies to pregnancy, fluctuations in blood pressure, stress and depression.  I also agree that HB shall not be responsible for any complications or incidents resulting from any matters not disclosed by me.

4.3 I understand that the HB will expect me to put in a few minuets of my time each day towards some activity that will aid my healing process and I agree to undertake this responsibility for the duration of my treatment with them.


I understand that the HB will take reasonable measures to maintain all information provided by me as confidential.


6.1      The Healing Boutique,, AshMethod, Help Yourself Get Unstuck are all the protected intellectual property of the HB.

6.2      I acknowledge that the Healing Boutique’s treatments and therapies are designed by them and are unique and I unequivocally agree to that I shall regard their techniques, processes and procedures that I may be exposed to in the course of my therapy as their intellectual property. I acknowledge that such information is imparted for my personal use and I agree not to teach or impart these methods to any other person whatsoever with out the express permission of the HB. Anything to the contrary will amount to an infringement of the HB’s Intellectual Property rights.

6.3      I am hereby warned as every treatment/ therapy is specifically designed for him/her physical, mental and emotional condition, should the I impart the treatment/therapy or aspects of the same to any other individual it I am aware that may be detrimental to that individual party and I am responsible solely for their consequences. The HB accepts no responsibility for any such acts, actions or omissions mine and reserves the rights to have the me indemnify them fully for any and all costs, including incidental costs, damages, including damage to its reputation, liabilities etc. which ensue from the breach of Clause 6 of this undertaking.


7.     WEB SITE 

7.1 is the official web site of the HB and has been developed to provide general public information, which is subject to change without notice. The documents and information displayed in the site are for reference purposes only.

7.2 The content on the site is updated at the sole discretion of the HB. Although the HB shall attempt to keep its web information accurate and timely, no representations, warranties or guarantees whatsoever are made as to the accuracy, adequacy, reliability, completeness, suitability or applicability of the information, text, graphics, hyperlinks, and other items contained on this server or any other server.


8.1 This Agreement constitutes the entire Agreement between me and the HB with respect to the subject matter hereof, and supersedes all prior representations, negotiations, writings, memoranda and agreements, either oral or written, with respect thereto.

8.2 This undertaking shall be retroactively applicable from the date that it is signed through the conclusion of my treatments with the HB. Having read, I hereby sign it confirming that I understand and agree to be bound by all of its contents.

 Signed :

Mr/Mrs/Ms/Dr  _________________________________




Date:  ______________