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2026 Client Disclosure, Informed Consent, and Liability Waiver

Chance for Change Institute, Inc.
LOVE NOW Energy Alignment Services
Client Disclosure, Informed Consent, and Liability Waiver

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Question 1 of 17

1. Nature of Services

I understand that energy alignment services are rooted in The L.O.V.E. NOW Method™ and are designed to promote self-regulation, emotional balance, resilience, clarity, personal leadership, embodiment, and overall well-being. 

Services are grounded in the scientific fields of:

⚫Neuroscience (brain–body integration, neural patterning)
⚫Polyvagal Theory (nervous system states and regulation)
⚫Somatic Psychology (embodied awareness and emotional integration)
⚫Trauma Science (trauma-informed nervous system support)
⚫Psychophysiology (stress response + vagal tone)
⚫Bioenergetics (breath, energy flow, and physiological/emotional release)

 

A

I understand

B

I don't understand

Question 2 of 17

I agree to participate at my own pace, and I may pause or stop at any time. Services may include:

⚫Conscious or connected breathwork
⚫Somatic and nervous-system-based practices
⚫Energy flow alignment techniques
⚫Subtle body guidance (chakras, meridians, energetic centers)
⚫Emotional release tools
⚫Coaching around leadership, self-regulation, and purpose
⚫Guided visualization or inner inquiry

A

I understand and agree

B

I don't understand

C

I don't agree

D

I don't understand or agree

E

I need more information

Question 3 of 17

2. Energy Alignment Services Do Not Replace Medical or Mental Health Treatment

 

I understand and agree that:

⚫Energy alignment services are not intended to diagnose, treat, or cure any medical or mental health condition.
⚫They complement mental health or medical services; they do not replace them.
⚫Jody Marquis is not acting as a licensed physician, therapist, or medical provider.
⚫I am responsible for seeking licensed medical or therapeutic support when needed.
⚫I will disclose any relevant health conditions so the work remains safe and appropriate.

A

I understand and agree

B

I don't understand

C

I don't agree

D

I don't understand or agree

E

I need more information

Question 4 of 17

3. Voluntary Participation

 

I understand and agree that I voluntarily choose to receive energy alignment services and that I may withdraw at any time. I agree to disclose any conditions that may require precaution.

A

I agree

B

I don't agree

Question 5 of 17

Medical & Physical Considerations

(Select all that apply)
A

I do not have uncontrolled high blood pressure

B

I do not have heart disease, cardiovascular issues, or stroke history

C

I do not have epilepsy or a seizure disorder

D

I have not had recent major surgery

E

I do not have severe asthma or respiratory disease

F

I am not pregnant (or I have consulted my provider)

G

I have informed, or will inform, Jody of any other chronic or acute medical concerns

Question 6 of 17

Mental & Emotional Considerations

(Select all that apply)
A

I am not currently experiencing active psychosis

B

I do not have untreated bipolar disorder

C

I do not have a diagnosed dissociative disorder

D

I have disclosed relevant mental health history

E

I understand that deep breathwork can activate emotions and memories

Question 7 of 17

4. Possible Short-Term Effects of Somatic and Energy Clearing Work

 

I understand and agree that by engaging in energy alignment, breathwork, and nervous system recalibration, I may temporarily experience:

 

⚫Fatigue or increased need for rest
⚫Emotional sensitivity or release
⚫Feeling “off” or unsettled
⚫Physical sensations or tension release
⚫Digestive changes
⚫Lightheadedness or tingling
⚫Sleep fluctuations
⚫Energy surges or temporary dips
⚫Flu-like symptoms
⚫Increased awareness of thoughts, patterns, or emotions

 

These responses are commonly recognized as part of somatic processing, energy clearing, and nervous system integration. I understand that they usually last no more than 24–72 hours. I agree to communicate with Jody if I experience anything concerning.

A

I understand and agree

B

I don't understand

C

I don't agree

D

I don't understand or agree

Question 8 of 17

Safety & Self-Awareness

(Select all that apply)
A

I take full responsibility for adjusting or stopping a session if I feel discomfort

B

I understand breathwork can temporarily intensify emotions

C

I agree to stay connected to my breath, body, and safety throughout

D

I understand I may experience short-term clearing symptoms

Question 9 of 17

5. Personal Responsibility

 

I acknowledge that no outcomes or specific results are guaranteed and that I am responsible for my:

 

⚫physical well-being
⚫emotional and mental state
⚫choices during and after sessions
⚫integration practices

A

I agree

B

I don't agree

Question 10 of 17

6. Confidentiality & Communication

 

I understand that:

 

⚫All sessions will be kept confidential, within legal and ethical limits
⚫Notes may be kept for professional purposes
⚫Communication for scheduling and integration may occur via text or email

A

I understand and agree

B

I don't agree

Question 11 of 17

7. Release of Liability & Consent

I understand that, by electronically signing this agreement, I release and hold harmless:

Jody Marquis, Chance for Change Institute, and all its affiliates from any liability, claims, or damages arising from participation in these services.

A

I understand and agree

B

I do not understand or agree

Question 12 of 17

Consent

(Select all that apply)
A

I voluntarily choose to participate in energy alignment work

B

I understand this work is complementary and not medical or mental health treatment

C

I have had the opportunity to ask questions

Question 13 of 17

8. Purchase Agreement

I understand that all sales are final and that I may not request a refund.

A

I understand

Question 14 of 17

I understand that if I need to change a scheduled session, I must provide 24 hours notice.

A

I agree

Question 15 of 17

 

I understand that if I do not show up for my scheduled session, or if I provide less that 24 hours' notice when asking to reschedule my session, I forfeit my session and I will not receive a refund.

A

I agree

Question 16 of 17

I understand that if I do not provide 24 hours notice, my scheduled session will not be rescheduled.

A

I understand

Question 17 of 17

9. Acknowledgment & Agreement

By providing my details, I affirm that I have read this Waiver, understand it fully, and agree to its terms.

 

(Please type your name and today's date in the space below.)

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