Hi there. Please read over the following important legal information carefully and answer honestly.

Scope of Practice:

I understand that TRE is provided for the purpose of relaxation, autonomic nervous system regulation, pain reduction, and the releasing and or reduction of stress, tension, and trauma. I understand that TRE has not been evaluated by the US Food & Drug Administration or the American Medical Association. This process is not intended to diagnose, treat, cure, or prevent any disease. TRE is a modality in the field of alternative healthcare. I have been informed that TRE is not a substitute for medical treatment or diagnosis and that I should consult a healthcare professional for any medical concerns before proceeding. I confirm that I have disclosed my known medical, physical, and psychiatric conditions, provided honest answers to all questions, and agree to inform the practitioner of any changes in my medical history. Results may vary between individuals. There are no guarantees, expressed, or implied.

I understand that the practitioner will do his best to keep me, my body, and my nervous system in a level of safety and comfort, but that it is ultimately my responsibility to go at a pace that is best for me and my body. Any activity can have some risk involved. By participating in this session, I agree that I am volunteering to take part in the practice at my own risk.

PRECAUTIONS:

By signing below, I am verifying that I am not pregnant and there is no chance that I could be pregnant.

I understand that if I have been diagnosed, currently or in the past, with any of the following below, I have both notified the practitioner and I have received my physician’s, psychiatrist’s, therapist’s, or doctor’s approval to proceed with the TRE process.

• Irregular Blood Pressure (High or Low)
• Irregular Heart Conditions(surgery, pace makers, arrhythmia)
• Physical Limitations(broken bones, strains, sprains, operations still under a physician’s care)
• Hypo or Hyperglycemia (medications)
• Epilepsy
• Severe PTSD
• C-PTSD
• Manic/depressive
• Bi-polar conditions
• Schizophrenia
• Severe Depression
• Psychosis
• Borderline
• Dissociative Disorders
• Concussion
• Head or Brain Injuries
• Chronic illness such as
• CFS, POTS, MCAS, Lyme, or anything similar

The practitioner reserves the right to cancel my session without refund, if any of these precautions apply to me, and I have not informed him and received my physician’s, psychiatrist’s, therapist’s, or doctor’s approval.

CONFIDENTIALITY:

All of the information that I share with the practitioner will be kept confidential unless a written release is approved and signed my me. However, information I share may be shared without requiring a release by me, if required to do so by law.

SCOPE OF LEARNING:

I will be taught how to practice TRE® for my personal use only. This is not a certification course and I will not be qualified to teach TRE® to others. If I teach TRE® to anyone else, I accept full liability for any claim, suit, or proceedings brought against me by anyone I teach, thereby releasing Evan Ritter(practitioner),Mountain and Meadow Health,LLC, TRE® LLC, and Dr. David Berceli from any legal, financial, and medical liability that may be incurred.

CANCELLATION POLICY:

• Non-Discounted Group Sessions-Any member of a group session needing to reschedule with more than 7 days notice will be issued a 50% refund and a new appointment will need to be made.
• Discounted Group Sessions-If a group member needs to cancel, and this is done 7 or more days before the session, then I may give the group member a partial refund at my discretion.
• There are no refunds to a group member who cancels less than 7 days prior to the start of any group session.
• If Evan Ritter has to cancel for any unforeseen reason, a full refund will be made.
• Private sessions may be re-scheduled up until 48 hours beforehand.
• Any private sessions needing to be rescheduled with less than 48 hours notice will be treated as cancellations, charged in full, and a new appointment will need to be made.
• There is no re-imbursement if any appointments or classes are missed, if you choose not to continue partway through a session, or if the above mentioned precautions apply to you.

Client Acknowledgments:

• I, the undersigned, acknowledge the following:
• I understand that the TRE practitioner is not a medical professional or psychotherapist, and TRE is not a substitute for medical treatment or diagnosis.
• I have provided accurate information about my health, medications, recent or relevant traumas, and medical history and will inform the practitioner of any changes in my health or medical profile.
• I am free to stop TRE at any time if I feel discomfort, pain, or any other issue.
• I understand the TRE practitioner reserves the right to refuse services to me for any reason that he deems necessary.
• I have received a copy of the Practice Policies. I understand them and agree to abide by them.
• I, hereby, voluntarily consent to participate in this TRE session or TRE session package. I understand the nature of TRE and its purpose. I release Evan Ritter, Mountain and Meadow Health,LLC, TRE LLC, and Dr. David Berceli from any legal, financial, and medical liability that may be incurred.