Birthday

I agree to, understand, and acknowledge that the discussions, consultations and session(s) I have with Jennifer Scott, the Releasee: are not intended to replace any relationship I have with my healthcare or mental health provider(s).*

I agree to, understand, and acknowledge that the discussions, consultations and session(s) I have with Jennifer Scott, the Releasee, that I am responsible for the outcome(s). *

I agree to, understand, and acknowledge that the discussions, consultations and session(s) I have with Jennifer Scott, the Releasee, does not come with any guaranteed outcome or warranty. *

I agree to, understand, and acknowledge that the discussions, consultations and session(s) I have with Jennifer Scott, the Releasee, I assume full complete responsibility for any known or unknown risk.*

n my personal name, that of my heirs and assignees, I exonerate and totally and indefinitely release the relinquished of any suit, complaint, declaration, damage, cost and/or expense of any kind in resulting from any discussion, consultation or sessions.*