Counseling, Clinical Consultation, and Coaching Waiver Release Form For Clients of Therapeutic Counseling Services of San Antonio

FOR AND IN CONSIDERATION OF Rhonda (formerly Devlin) Katan, R.N., F.M.P., B.C.B.T., Lic. Min., Cert. Life/Wellness Coach and Therapeutic Counseling and Wellness Services of San Antonio (hereafter called: TCWSSA) provisions of faith-based and guidance counseling services, clinical consultation, and life/wellness coaching, the undersigned, being legally competent, does hereby RELEASE and FOREVER DISCHARGE Mrs. Katan from any and all actions, causes or action, claims, demands, damages, costs, and any and all known and unknown personal injuries, mental anguish, and damage claims arising out of or related to counseling, ministerial services, clinical consulting, and coaching services provided by TCWSSA and/or their agents, representatives and/or employees in any way affecting the undersigned.

THE UNDERSIGNED understands the nature of the ministerial, counseling, clinical consulting, and coaching services to be provided have been fully explained to me prior to receiving such services with full knowledge and understanding of the nature of the ministerial, counseling, clinical consulting, and coaching services. I therefore waive any and all claims for damages arising out of or in any way related to psychological, physical, and spiritual problems which have brought me to Mrs. Katan.

THE UNDERSIGNED further AGREES to indemnify and hold harmless Mrs. Katan from any and all claims and damages of any and all kind arising out of or attributed to the psychological, physical, and spiritual problems which brought the undersigned to Mrs. Devlin, or any point after the date of this release.

IT IS FURTHER UNDERSTOOD AND AGREED that this waiver and release constitutes an admission and acknowledgement by the undersigned that no warranty, guarantee, or promise of any particular result, either expressed or implied, has been received from Mrs. Katan. The undersigned acknowledges and agrees that the very nature of the undersigned’s problems is necessarily such that no specific results can be promised or warranted by any such ministry, counseling, clinical consulting, and coaching services.

THIS RELEASE contains the entire agreement between the parties hereto, and the terms of this waiver and release are contractual and not merely recital.

THE UNDERSIGNED further stated the foregoing release has been carefully read and understood by the undersigned, who signs the same of the under signer's own free act and deed.

As a client, I understand I am requesting Rhonda Katan to serve as my faith-based and guidance counselor, clinical/wellness consultant, and personal coach. I understand that Mrs. Katan is a Board Certified Faith-Based Therapist, Registered Nurse, Licensed Minister, has a degree in Psychology, and serves as a Functional Medicine Practitioner/ Consultant. Mrs. Katan functions exclusively as a faith-based and guidance counselor, clinical consultant, coach, and educator, thus cannot prescribe medications, or officially diagnose a medical problem whether physical or mental. I understand that any evaluation, remedy, or advice submitted by Mrs. Katan, whether verbally or in writing, is not intended as a substitute for the care of a medical doctor or psychiatrist. I will seek an opinion from a physician or psychiatrist for any current or future medical or mental health concerns if I deem I am in need of that type of service.

During consultations Mrs. Katan may inquire about physical and mental health status. She will provide recommendations for improved general health. This advice may include fitness coaching, nutritional coaching, spiritual/emotional coaching, counseling, homeopathic, herbal, and other supplementation coaching, stress management, motivational interviewing, clinical consultation, lab consultation, and preventative/intervention health consultation. Mrs. Katan makes no guarantees or warranties, expressed or implied, about any results to be achieved or product viability. As the client, I understand these consultations are only recommendations and that any actions and decisions are ultimately my own. At this time, I agree to waive, release, and forever discharge Mrs. Katan from personal or financial liability for any injury or damage to myself resulting from counseling, clinical consultation, coaching and/or activities that are connected with participation in counseling, clinical consultation, and personal or wellness coaching.

I understand that I have the right in the counseling, clinical consultation, and coaching experience to self-disclose what I choose, but I also recognize that the best results will be achieved by providing accurate information during discussions. This information will be held in strict confidence and will only be disclosed with my written permission with exceptions including suspected cases of abuse, or an expressed intent to harm myself or another person. I hereby give my informed consent to engage in the above mentioned process with Mrs. Katan.

Updated January 22, 2022