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Release of Liability Form
Please fill out the following form
in order to receive our services.
Date of Birth
Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?
If you answered yes to any question, please elaborate
I declare my awareness and acceptance: That the information I have provided in the attached form is accurate and complete. That Metaphysical Healing is not intended to replace orthodox medicine, but rather to complement it. If symptoms persist or the ailment is severe, I will consult a Medical Doctor in a timely manner. That Astrology points only toward potentials. It is up to me to use my discernment regarding the information that I receive. That I hereby release Quintile Astromancy, it's owner/operator Jacob Miller DBA Tully Astromancer, as well as any and all affiliates, venues, connected organizations and persons, from all legal recourse that may arise from the information and services provided.
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