Please read this document carefully. By signing below, you acknowledge that you have read, understood, and voluntarily agree to all the terms, disclosures, and releases of liability contained herein.

1. Nature of the Work & Scope of Practice

I understand and agree that the services, classes, and mentorship series offered by Anna DiPilla (the "Practitioner") are purely educational, somatic, and energetic in nature.

• Somatic Tracking & Coaching: Focuses on developing mindful awareness of bodily sensations, nervous system regulation, and emotional integration.

• Reiki & Energetic Healing: Involves subtle energy balancing, clairsentient tracking, and alignment of the energetic field.

No Medical or Psychological Treatment: I explicitly acknowledge that the Practitioner is not a licensed medical doctor, psychiatrist, psychologist, or clinical mental health counselor.

• These sessions, classes, and trainings do not constitute medical advice, physical therapy, psychiatric diagnosis, or clinical psychotherapy.

• I understand that these modalities are complementary in nature and are not intended to replace, override, or substitute for professional medical or mental healthcare.

2. Client Responsibility & Psychological Grounding

I acknowledge that deep somatic tracking, intuitive development, and energy work can involve deep emotional and physiological integration.

• Self-Regulation: I agree that I am fully responsible for my own physical, mental, and emotional well-being before, during, and after all sessions or classes.

• Medical Consultations: I agree to seek the care of a licensed primary healthcare physician or mental health professional for any physiological or psychological conditions, acute symptoms, or medical diagnoses.

• Medication: I agree that I will not alter, reduce, or stop any prescribed medications or medical treatments without first consulting my prescribing healthcare professional.

3. Assumption of Risk

I voluntarily choose to participate in private sessions, classes, workshops, or training series with the Practitioner. I recognize that somatic work, breathwork, and energetic shifting can sometimes bring up intense physical sensations, repressed emotions, lightheadedness, or temporary fatigue as the nervous system processes and integrates. I freely and completely assume all risks, both known and unknown, associated with my participation.

4. Cancellation, Rescheduling, & Attendance Policy

• 24-Hour Policy: I agree to provide at least 24 hours’ notice for rescheduling or canceling a private session. I understand that cancellations or missed appointments with less than 24 hours’ notice will be charged the full session fee.

• Series Attendance: For group programs, practitioner series, and workshops, registration fees are non-refundable once the container has commenced, as space is limited.

5. Release of Liability

In consideration of the services provided by Anna DiPilla, I, on behalf of myself, my heirs, executors, administrators, and personal representatives, hereby release, waive, and forever discharge Anna DiPilla and any associates, assistants, or guest instructors from any and all claims, demands, causes of action, damages, or liabilities of any kind arising out of my participation in private sessions, classes, or practitioner training series.

I agree that I will not bring any legal action or make any claims against the Practitioner for any perceived negative physical, emotional, or energetic consequences resulting from the application of the tools, guidance, or teachings shared in this work.

6. Confidentially & Container Integrity

I understand that all personal information shared during private sessions is kept strictly confidential, except as required by law (such as imminent threat of harm to self or others).

For Group Classes and Practitioner Series, I agree to maintain the strict confidentiality of my peers in the group. I will not share, broadcast, or discuss the personal details or experiences of other participants outside of the classroom container.

Acknowledgment & Signature

By signing below, I certify that I have read this document in its entirety, that I fully understand its terms, and that I agree to be bound by them. I acknowledge that I am signing this agreement freely and voluntarily.

• Client Printed Name: ______________________________________

• Client Signature: _________________________________________

• Date: ________________________