Client Consent Form

LIABILITY: This waiver of liability includes any risk of attending The Sacred Womb Ltd sessions, engaging in virtual sessions, coaching or attending any events, workshops, training or other services provided by The Sacred Womb Ltd. For the purposes of this form you are know as ‘the client’ and Melanie Swan is referred to as ‘the therapist’,

Clients using The Sacred Womb Ltd. services should understand that these services are not offered as a substitute for clinical mental health care or medical care and are not intended to diagnose, treat or cure any mental health or medical conditions. I also understand that my therapist or coach is not acting as a medical professional. Clients will understand and agree that they are fully responsible for their own well-being during their coaching and therapy sessions, and subsequently, including their choices and decisions. Clients will also understand that all comments and ideas offered by a Therapist are solely for the purpose of aiding the client in achieving their defined goals or in having a good conversation with a qualified therapist in order to improve or enhance their mental well being or mental maintenance. The client will be able to give informed consent, and hereby give such consent to their therapist to assist them in achieving such goals.

Any medication presently being taken pursuant to medical advice should not be discontinued without obtaining approval from your health care practitioner. As a client, I take complete responsibility for my own mental, physical and emotional well-being. In signing this release, I hereby waive and release Melanie Swan of The Sacred Womb Ltd. from any and all liability past, present and future relating to any and all sessions and services provided by The Sacred Womb Ltd.

Clients will be aware you will be receiving services from The Sacred Womb Ltd in accordance with UK law and any contractual disputes will be subject to UK laws. For all international clients all therapy, coaching and training services are undertaken in accordance with the UK law and any disputes will be subject to UK law. 

CONFIDENTIALITY: Sessions between the therapist and the client are strictly confidential. Any notes taken by the therapist, audio recordings, video recordings during therapy and emails between the therapist and client shall be kept confidential and secure by the therapist at all times and shall not disclose it to anyone without any prior written consent by the client, with exception to certain limitations by law such as:

1. Abuse to a child, disabled, elderly, other people;
2. Criminal Acts;
3. Sexual Abuse;
4. Acts which may involve the transmission of HIV/AIDS;
5. Where a client presents a danger to self, to others, to property.
6. Fraudulent activities.
7. Any other instance where the therapist has a duty or he or she has a firm belief that there is a necessity to disclose.

EMERGENCY: If there is an emergency during therapy, or in the future after termination, where the therapist becomes concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, the therapist will do whatever they can within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, the therapist may also contact the person whose name you have provided and / or your doctor.

COURT PROCEEDINGS: In case of a court proceeding involving the client, it is agreed that the therapist cannot testify, such as but not limited to, custody proceedings, divorce proceedings, injuries, or any other lawsuits that shall result in the disclosure of the records of the therapist about his/her client.

CONSULTATION: The therapist may consult with other qualified professionals regarding clients; however, each client’s identity remains completely anonymous and confidentiality is fully maintained.

PAYMENT FOR SESSIONS: Clients are expected to pay the standard fee per session 24 hours before each session unless other arrangements have been made. Telephone conversations, writing and reading of reports, release of information, reading records, longer sessions, travel time, etc. will be charged at the same rate, unless indicated and agreed upon otherwise. The Sacred Womb Ltd. does not hold any card information on file through Acuity Scheduling, unless the client has themselves opted to save their card details securely on the Acuity Scheduling system.

SOCIAL NETWORKING: Melanie Swan does not accept friend requests from current or former clients on Facebook, as this can compromise your privacy and confidentiality. For this same reason, Melanie request that clients you don’t communicate with her via any interactive or social networking web sites. Following The Sacred Womb on Instagram is however ok.

AUDIO OR VIDEO RECORDING: Unless otherwise agreed to by all parties beforehand, there shall be no audio or video recording of therapy sessions, phone calls, or any other services provided by me.

TERMINATION: You have the right to terminate therapy and communication at any time. If you choose to do so, upon your request and if appropriate and possible, Melanie will provide you with names of other qualified professionals whose services you might prefer.

CANCELLATION & RESCHEDULING: Since the scheduling of an appointment involves the reservation of time specifically for you, a minimum of 48 hours (2 days) notice is required for re-scheduling or cancelling an appointment. Unless we reach a different agreement, the full fee will be charged for sessions missed without such notification.

LATE ARRIVAL: If you are more than 10 minutes late for a scheduled session, your session will be ended with no refund due. If you are running late, you can let Melanie know by email and she will wait for you.

CANCELLATION DUE TO ILLNESS: If you are genuinely ill and can’t attend your appointment, please give as much notice as possible. Your session will be cancelled with no payment due, and will be rescheduled at a mutually convenient date and time.

Client Consent Form