I have chosen to be treated with acupuncture, nutritional counseling or energy healing or I am participating in the Total Life Cleanse, by Jonathan Glass ND, M.Ac, at the Healing Essence Center.  All treatments are intended to improve body function, wellbeing, or relieve pain.  I understand that although rare, side effects may occur which could include: minor discomfort, pain, localized bruising, nausea, or temporary aggravation of preexisting conditions.  

Although most patients experience the varied benefits of these treatments and programs, I understand that no guarantee is made concerning results.  

I also confirm that at present, I do not have a fever, sore throat, cough or suspect any contagious illness.

I understand full payment is made at the time of each treatment unless otherwise arranged.  I agree to the Healing Essence cancellation policy stating that I must give at least 24 hour notice to cancel my appointment or I will be responsible for 50% of the cost of the treatment.