Therapy Release Form
I understand that any therapy I may receive from Joy Black / Good Energy for Life is alternative

or complementary to healing arts licensed by the State of Virginia and in no way substitutes for

appropriate medical intervention, body therapy, or psychotherapy.

I also understand that my practitioner, Joy Black, is not a licensed physician, but has achieved

certificates of completion for the therapies that she offers. She is also experientially qualified to

make suggestions for my self-care.

I further understand that these holistic energy therapies emphasize compassionate, heart-centered

care. Gentle, non-invasive touch on or off the body is used to restore harmony, energy and balance

within the human energy system, thus affecting physical, emotional, mental and spiritual health

and healing. Numerous benefits are possible. These effects may vary depending on each

individual’s response patterns. I know that I am responsible for my own physical, emotional,

mental, and spiritual well-being.

Although there are no known harmful effects from this type of intervention, I hold my practitioner

harmless from any possible effects that may cause temporary discomfort and agree to take full

responsibility for my self-care and personal development.

Email address *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.