Informed Consent

 

Signing up for a treatment with Ethan Borg is your consent to this Agreement

 

I am offering you Fu Xi Wen or Qi Gong treatments free of charge on the Worldwide Web provided that you understand that you must be 18 years of age or older; that you must read or have read to you and sign this Informed Consent; and, that you agree freely and fully to all its provisions without reservation for yourself or for anyone for whom you hold a valid Medical Power of Attorney.

Any treatments offered should be understood to be only within the ambit of Fu Xi Wen or Qi Gong treatments and do not correlate in any instance or particular to Western medicine even though the terms may seem familiar.

By signing this Informed Consent you also signify that you are not or could not be pregnant.

You should further understand that no diagnosis has or can be made of your symptoms or illness and that any diagnosis should be made by your family or personal physician. Your attending physician must be in charge of any treatment as well as diagnosis. Fu Xi Wen or Qi Gong treatments are intended to supplement or enhance any course of treatment only.

You agree that Ethan Borg as an individual shall bear no liability for any treatment or condition whatsoever including but not limited to any consequential, indirect, or special claimed damages. You agree to indemnify and hold harmless Ethan Borg as an individual for any and all claims or damages which you may seek to assert. By signing this Informed Consent, you hereby accept and acknowledge all risk arising from any treatment offered by Ethan Borg as an individual practitioner of Fu Xi Wen and Qi Gong.

By signing this Informed Consent, you accept that the laws of liability shall be construed in accordance with the laws of the State of New York and you also accept the jurisdiction of the Courts of the State of New York.

You agree that your scheduling and/or purchase of an EM Energy Medicine Treatment from Ethan Borg through this website or directly with Ethan Borg is your signing of this Agreement.


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