Informed Consent & Liability Waiver 

Silver Root Health Consulting Studio

Location: 113 Spring Street, New York, NY 

Client Name: _______________________________ 

Date: ___________________ 

Purpose of the Consultation 

I understand that I am voluntarily participating in a 1:1 Energy Mapping consultation provided by herbalists from Silver Root Health Consulting Studio. The consultation is intended for educational, wellness, and lifestyle support purposes only and may include discussion of traditional herbal philosophies, constitutional patterns, nutrition, lifestyle habits, wellness practices, and traditional energetic concepts. 

I understand that this consultation is not medical care.

No Medical Diagnosis or Treatment 

I acknowledge and understand that: 

• The herbalists conducting this consultation are not acting as medical doctors during this session.
• No medical diagnosis, treatment, prescription, cure, or prevention of any disease or medical condition will be provided.
• The consultation does not replace care from my physician or other licensed healthcare provider.
• I should consult my healthcare provider regarding any medical concerns, symptoms, medications, pregnancy, or health conditions.
• I should never discontinue prescribed medications or medical treatment based on information received during this consultation without consulting my licensed healthcare provider. 

Voluntary Participation 

I understand that my participation is voluntary. I may decline to answer questions, decline recommendations, or end the consultation at any time. 

Herbal Education 

If herbs, teas, supplements, or wellness practices are discussed, I understand that: 

• Any recommendations are educational and wellness-oriented.
• Results vary between individuals.
• No guarantees or promises regarding outcomes have been made.
• I am responsible for determining whether any herbal product is appropriate for me, particularly if I am pregnant, nursing, taking medications, have allergies, or have existing medical conditions.  

Assumption of Risk 

I understand that participation in wellness consultations and the use of herbal products may involve risks, including but not limited to: 

• Allergic reactions
• Digestive upset
• Skin irritation
• Unexpected sensitivities
• Herb-drug interactions
• Herb-supplement interactions
• Temporary discomfort
• Changes in energy or wellness perception
• Individual variations in response
• I voluntarily assume all known and unknown risks associated with participating in this consultation and with any decision I make following the consultation. 

Release of Liability 

To the fullest extent permitted by law, I release and hold harmless Silver Root Health Consulting Studio, its owners, herbalists, employees, contractors, affiliates, and representatives from any and all claims, liabilities, damages, injuries, losses, costs, or expenses arising out of or relating to my participation in this consultation or my independent use of any information, herbs, supplements, or wellness recommendations discussed. 

This release includes claims arising from ordinary negligence but does not apply where prohibited by applicable law or to gross negligence, reckless conduct, or intentional misconduct. 

Medical Emergencies 

I understand that if I am experiencing a medical emergency or serious symptoms, I should immediately contact emergency medical services or seek care from the nearest emergency department. 

Confidentiality 

Information shared during the consultation will be treated as confidential to the extent permitted by law. I understand there may be legal exceptions requiring disclosure, including situations involving imminent risk of harm or where disclosure is otherwise required by law. 

Acknowledgment 

By signing below, I acknowledge that: 

• I have read and understand this document.
• I have had the opportunity to ask questions.
• I understand the consultation is educational and wellness-focused.
• I understand that no medical diagnosis or treatment is being provided.
• I voluntarily assume the risks described above.
• I voluntarily agree to the terms of this informed consent and liability waiver.