MB-EAT

MY CONSENT TO PARTICIPATE

This program is a twelve-week course comprised of learning awareness and meditation techniques, instructions and teachings on various aspects of managing my symptoms and discussing weekly assignments. I am aware that it will demand my time and resources.

This program includes many persons with varying backgrounds, strengths and difficulties. I am aware that maintaining confidentiality of the information that is shared with me is crucial to encouraging feelings of openness and security.

This program is conducted by a qualified MB-EAT trainer who is required to comply with legal limits of confidentiality. I am aware that disclosures of threat to myself or others, unreported physical, sexual or emotional abuse of children, unreported sexual abuse by health care professionals, and/or presentation of subpoenas or search warrants must be complied with or reported to appropriate authorities.

CANCELLATION POLICY

We will do our best to meet your needs if you cannot attend the course as planned. If you need to cancel due to illness please let us know as soon as possible. The following refund schedule will be applied to cancellations:

After first class: Amount paid less $100.00 (administration fee)

After second class: No fee refund

RECEIPTS

If you are submitting through insurance, it is your responsibility to inquire with your plan to determine eligibility requirements. We will accommodate any reasonable requests for alternate billing arrangements.

Please note that, unless specified otherwise, your receipt for insurance purposes is distributed at the fifth class. You will be provided with one receipt for the full fee distributed over the first five classes at $139.00 per session (total $695.00)