Complementary Wellness, Spiritual & Ceremonial Services
Participant Consent, Informed Acknowledgment & Disclaimer
Purpose of this form. This agreement helps participants understand the nature and limits of complementary wellness, spiritual, ceremonial, and educational services offered or facilitated through Amor Latino Counseling Center, Inc. It is separate from psychotherapy informed consent and does not replace consent required for licensed clinical services.
1. Nature of Services
Depending on the program selected, services may include Reiki or energy-based practices, sound bowls or other sound experiences, guided meditation, gentle breath practices, somatic or grounding exercises, spiritual counseling, ritual, ceremony, ancestral or Earth-based practices, reflective exercises, group circles, retreats, and other complementary wellness experiences. Participation is voluntary, and participants may decline any activity at any time.
2. Not Medical Treatment or Psychotherapy
Complementary wellness and spiritual services are not substitutes for medical care, psychiatric care, psychotherapy, emergency services, diagnosis, or treatment by an appropriately licensed healthcare professional. Participation in a wellness, spiritual, or ceremonial offering does not by itself create a therapist-client relationship. If I also receive psychotherapy through Amor Latino or an affiliated clinician, those services are governed by separate clinical consent and privacy documents.
3. Voluntary Participation and Personal Choice
I may ask questions, request modifications, choose not to participate in a particular exercise, or stop participating at any time. Spiritual language, ritual, prayer, ancestral practices, or ceremonial elements are optional unless a program has been clearly identified in advance as a specifically spiritual or religious offering.
4. Possible Experiences and Risks
Complementary practices may produce physical, emotional, sensory, or reflective responses, including relaxation, fatigue, tingling, warmth, emotional activation, memories, changes in breathing pattern, temporary lightheadedness, or a desire to rest. Sound-based experiences may feel intense for some people. Breath practices may not be appropriate for every person or every health condition. I agree to communicate discomfort promptly and to participate within my own physical and emotional limits.
5. Health and Safety Disclosure
I agree to inform the facilitator of relevant health considerations that could affect safe participation, including significant cardiovascular or respiratory conditions, seizure disorders, pregnancy, recent surgery or injury, fainting history, or other conditions for which altered breathing, prolonged lying down, sensory stimulation, or movement may require modification. When appropriate, I will consult my healthcare professional before participating. Facilitators may recommend modification, postponement, or referral when safety concerns arise.
6. Breathwork
Breath practices offered in these programs are intended for wellness, grounding, self-awareness, and regulation. I will not intentionally push beyond my comfort or capacity. I understand that I should return to normal breathing, sit or lie down safely, and alert the facilitator if I experience significant dizziness, chest pain, shortness of breath, panic, numbness, or other concerning symptoms.
7. Sound Healing and Vibrational Practices
Singing bowls, tuning forks, percussion, voice, music, or other sound tools may be used near or around the body. I may request lower volume, greater distance, or discontinuation of sound at any time. Sound and vibration are offered as complementary wellness experiences and are not represented as cures or guaranteed treatment for medical or psychiatric conditions.
8. Reiki, Energy Work, Spiritual Counseling and Ceremony
Reiki, energy work, spiritual counseling, ritual, and ceremonial practices are complementary and may be interpreted through personal, cultural, religious, or spiritual frameworks. No particular belief is required. These services do not guarantee spiritual, physical, emotional, financial, relational, or medical outcomes.
9. Group Programs and Confidentiality
For group circles, workshops, retreats, or ceremonies, Amor Latino may establish confidentiality agreements and community guidelines. However, the organization cannot guarantee that another participant will maintain confidentiality after information is voluntarily shared in a group setting. I agree to respect the privacy of other participants and not record, photograph, post, or repeat another participant's personal disclosures without permission.
10. Minors and Parent/Guardian Consent
Programs involving children or adolescents must be developmentally appropriate and may require consent from a parent, legal guardian, or other authorized adult. Parent/guardian consent to complementary wellness programming does not replace separate consent required for clinical mental-health services. A child may be permitted to pause or decline an activity when developmentally appropriate and safe.
11. Emergency and Crisis Situations
Complementary wellness programs are not crisis-response services. If I or another participant appears to be in immediate danger or requires urgent medical or psychiatric intervention, appropriate emergency or crisis resources may be contacted. In the United States, call 911 for an emergency or call/text 988 for the Suicide & Crisis Lifeline.
12. No Guarantee of Results
Individual responses vary. No specific result is promised or guaranteed from Reiki, sound healing, breathwork, meditation, spiritual counseling, ritual, ceremony, somatic practice, or any other complementary wellness service.
Participant Acknowledgment & Consent
By signing below, I acknowledge that:
- I have read and understand this consent and disclaimer.
- I have had an opportunity to ask questions before participating.
- I understand the distinction between complementary wellness/spiritual services and licensed clinical treatment.
- I understand that participation is voluntary and that I may stop or decline an activity at any time.
- I agree to communicate relevant health or safety concerns to the facilitator.
- I consent to participate in the complementary wellness, spiritual, educational, or ceremonial service(s) I have selected.
If participant is under 18:
This form is intended for general complementary wellness and spiritual programming. Program-specific waivers, clinical informed consent, medical clearance, photography releases, or event policies may also apply.
Amor Latino Counseling Center, Inc.