with Dr. Ni-Cheng Liang and her associates, who may include Dr. Jessie Mahoney and/or Dr. Karin Schiff and/or Dr. Sara Dill.
Waiver of Liability
By reading this document and clicking accept on the registration page, you are requesting mindfulness teaching for enhancing your professional, and/or personal well-being. With regards to these services, Drs. Liang, Mahoney, Dill, and Schiff will serve only as mindfulness meditation teachers during this or these sessions and not as physicians. By clicking accept on the course registration, you agree and acknowledge that Drs. Liang, Mahoney, Dill, and Schiff are not providing medical care to you while you are in mindfulness classes and commit to seeking the care of a physician or therapist as needed for ongoing, or emergency, physical and mental healthcare. If you wish, Drs. Liang, Mahoney, Dill, and Schiff are happy to refer you to, and work in partnership with your physicians, physical and mental therapists, and coaches.
While Practitioners (Drs. Liang, Mahoney, Dill, and Schiff) are licensed in California as Medical Doctors, I am choosing to engage Practitioners as mindfulness meditation teachers while enrolled in this course. This involves participation in classes which include guided meditations, group discussion, and home practice.
Benefits, Alternatives & Risks: Benefits of mindfulness meditation include: greater relaxation, ease and feeling of overall well-being. Alternatives to mindfulness meditation include other self-help techniques and medical or psychological care. Risks of mindfulness meditation include distress, mental health issues which require referral to a suitable, licensed healthcare professional such as a primary care physician, psychiatrist, or psychologist, and dissatisfaction with results.
No Medical or Psychological Services: I am not engaging Practitioners for any medical or psychological or other healthcare services while attending their mindfulness classes. I understand that Practitioners in their services pursuant to this document, will not be diagnosing, treating, or claim to cure any medical or psychological or other condition, and that Practitioners’ services are not designed to replace conventional treatment methods of medical or psychological conditions. Practitioners do not handle medical emergencies of any kind while I am enrolled in this mindfulness course.
I am responsible for my own healthcare decision-making by obtaining any necessary consultations with appropriately licensed health care professionals such as physicians and psychologists. I agree to seek medical assistance or psychotherapy or any other appropriate physical or mental diagnosis and treatment from a duly licensed practitioner (such as a licensed medical doctor or licensed psychologist) if I find that these distressing aspects create a danger for myself or for others.
Not Replacing Current Medical Care. Practitioners are acting in a supportive consultative teaching capacity and not as physicians. Accordingly, Practitioners are not replacing care currently provided to me by other physicians or licensed healthcare providers, such as my current primary care physician, internist, gynecologist, cardiologist, gastroenterologist, psychiatrist, psychologist, pulmonologist or other specialty care professionals. I will maintain a relationship with a physician who is available to provide emergent and urgent care. If I encounter a medical emergency and am not able to obtain care from my primary care physician, I will contact 911 or report to a hospital emergency department. Practitioners do not provide on-call services.
No Claims or Guarantees: I understand that Practitioners make no representations, claims or guarantees that my medical problems or conditions will be cured, solved, or helped by Practitioners’ recommendations.
Referrals: I understand that Practitioners may recommend that I seek other types of treatment from other health professionals who are not affiliated with Practitioners. I understand that Practitioners do not supervise these professionals and is not responsible for them. I understand that they are not her employees and that they will bill separately for their services.
Assumption of Risk; Indemnity: I knowingly, voluntarily, and intelligently decide to receive the services described above, and I knowingly, voluntarily, and intelligently assume all risks involved in the same. As a result of my assumption of these risks, I agree to release, hold harmless, indemnify, and defend Practitioners from and against any and all claims which I (or my representatives) may have for any loss, damage, or injury arising out of or in connection with use of the treatments or services described above, or arising out of or in connection with referral to other practitioners or merchants for delivery of any services. As a result, I agree not to pursue a claim against any of the foregoing, if I am dissatisfied with the results of the above services.
Video-Coaching: Video coaching involves the use of audio-visual or other electronic communications to interact with you with respect to the services herein. The benefit is speed of communication and access without physical travel; risks include inadequate communication due to the lack of physical presence. Additionally, in rare circumstances, security protocols could fail causing a breach of privacy. The alternative is an in-person face to face visit.
Arbitration: Any dispute, claim, or controversy arising out of or relating to this Agreement or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this agreement to arbitrate, shall be determined by arbitration in San Diego, California, before one (1) arbitrator. The arbitration shall be administered by AHLA Alternative Dispute Resolution Service Rules of Procedure for Arbitration, in or near San Diego, California. Judgment on the award may be entered in any court having jurisdiction. This provision shall not preclude either party from seeking provisional remedies in aid of arbitration from a court of appropriate jurisdiction. The arbitrator may, in the award, allocate all or part of the costs of the arbitration, including the fees of the arbitrator. Each party has read and understood this Section (Arbitration) and understands that it thereby agrees to submit any claims arising out of this Agreement to binding arbitration, and that this dispute resolution provision constitutes a waiver of the Party’s right to a jury trial. HOWEVER, prior to either party initiating Arbitration of any dispute, the parties agree to attempt mediation of the dispute with a mutually agreeable trained mediator in or near San Diego, California. “Trained mediator” means a professional with actual training and experience in the field of Mediation and/or dispute resolution.
EACH PARTY HAS READ AND UNDERSTANDS THIS SECTION and UNDERSTANDS THAT BY CLICKING ACCEPT ON THE REGISTRATION PAGE IN AGREEMENT, THE PARTY AGREES TO SUBMIT ANY CLAIMS ARISING OUT OF, RELATING TO, OR IN CONNECTION WITH THIS AGREEMENT, OR THE INTERPRETATION, VALIDITY, CONSTRUCTION, PERFORMANCE, BREACH, OR TERMINATION THEREOF TO MEDIATION AND ARBITRATION, AND THAT THE DISPUTE RESOLUTION PROVISIONS SET FORTH IN THIS SECTION CONSTITUTE A WAIVER OF THE PARTY’S RIGHT TO A JURY TRIAL.
NOTE: DO NOT CLICK ACCEPT ON THE REGISTRATION LINK UNLESS YOU HAVE READ THIS DOCUMENT AND FEEL THAT YOU UNDERSTAND IT.
I have carefully read this form and acknowledge that I understand it. I have had opportunities to ask questions and accept and agree to all of the terms above. No representations, statements, or inducements, oral or written, apart from the foregoing written statement, have been made. If any portion of this form is held invalid, the rest of the document will continue in full force and effect.