Client intake form and disclaimer

Disclaimer
I have answered all sections of the Client form truthfully, and cannot hold Crystal Beckner accountable for any information that was not revealed to her.
I understand that the purpose of this Client form and the consultation is to help me learn about the symptoms that I may be experiencing.
I understand that essential oils may interfere with certain medications that I am taking, and that is the reason I was asked about medications on the Client form.
Understand that Crystal Beckner is not a physician and the consultation and subsequent visits are not to take the place of medical treatment from a licensed medical doctor.
I confirm that I have had seen a physician in the past 12 months and have disclosed any and all diagnosed conditions on the Client form.
I will notify my health care provider of any essential oils or blends that I may be using.
I understand that this consultation is for educational purposes only and not to diagnose or treat disease.
I understand that Aromatherapy is not regulated by the United States Food and Drug Administration. I understand that no guarantees are made regarding the results of aromatherapy methods. I am under no obligation to follow any recommendations.
I am of legal age and requesting a consultation from Crystal Beckner C.A.
Signature: __________________________________Date:_______________