Your signature below indicates that you understand the work you are about to do, and give consent for treatment.
1. I hereby authorize Wendyne Limber/Solutions Center for Personal Growth, Inc.to administer treatment to me (or my child), which may include psychotherapy, expressive therapy and or educational services.
2. I understand that this work is experiential group process designed for full expression of the whole and true self. I, the undersigned, hereby consent to participation in the psychotherapeutic use of the expressive therapies. I am aware that all of these agreements apply to Imagination Virtual Reality Process as well as the in-person program in Soulville.
3. I understand that this is a process, the intention of which is the furthering of my emotional, mental, physical and spiritual health. I understand that this process may involve touching or being touched by the therapists or touching or being touched by group members as stated above. I understand that the therapists will take all normal precautions to maintain physical safety during sessions but that I must assume all risks of accident resulting from unintentional movements.
4. I understand that student interns from Soul Studies Institute are part of the planning and facilitation of my process, and give permission to release information about myself to the therapy team.
5. I will be responsible for all charges for services provided by Wendyne Limber/Solutions Center for Personal Growth, Inc. as described above and understand the refund policy: No monetary funds will be refunded. Participants unable to complete the process will be given the opportunity to do individual sessions and/or other transformational workshops if a credit is applicable.
Participants are responsible for payment of the full fee for the process even if a weekly group or workshop is missed; tuition is for the “program” rather than individual weeks or session.
6. I understand that if I (or my child) am committed to this process and fully participate in all the experiences and activities, my life may become incredibly joyful, meaningful and wonderful.
7. I herby certify that I have read this entire form and that I have discussed any concerns related to any of its provisions with my therapist to my satisfaction. I agree and give my consent for treatment. I am excited about my transformation!