PURIFY ESSENTIAL WELLNESS

Confidentiality, Cancellation, Disclosure Terms and Conditions and Informed Consent Agreement

Between: ANNE-MAREE ZOFREA and PURIFY ESSENTIAL WELLNESS PTY LTD ABN 56 161 670 784 of 28/7 Bungan St Mona Vale NSW 2103 Tel:(02)99991641 and all employees, directors, agents and subcontractors including but not limited to LISA CLARK, REBECCA COMER and TRACEY McCONNELL (referred to below jointly as “Purify Essential Wellness”)

And:……………………...........…….(You).  

If you are under the age of 18 the definition of Client includes the child and parent/guardian and they will both be bound by the terms and conditions of this document. (referred to below as “You”) 

1.Personal Details and Health Information 

Please note that all of your answers will be kept confidential. Please provide us with all available information regarding your present state of health and medical history as well as provide all medical updates for future treatments (“Health Information”). Please note that all of this Health Information is required by us to make our assessment of your needs and to provide You with appropriate care. Please refrain from signing any forms issued by us until we answer any questions You may have to your satisfaction during your initial visit. 

2. Agree to Provide Updated Information and Provision of Services

You agree and acknowledge Purify Essential Wellness will provide You with services including but not limited to Reiki, Spiritual Healing, Health Coaching, Skin Care, Beauty Treatments, Therapeutic Massage, Circulatory Massage, Yoga, Herbal Medicine, Psychology, Bach and Bush flowers, space clearing spray, body products, supplements, essential oils, nutrition, hair tissue mineral analysis, angel intuitive, psychic mediumship, workshops, seminars and lectures, Reiki Master Teacher training Reiki level 1, 2, & 3, healings, meditations, Oracle Card and Clairvoyant Readings, diagnostic and therapeutic procedure(s), hands on and hands off the body treatments, cranial and chiropractic treatments, house & property clearings, animal consultations, group meditations, active meditations, books, handwritten notes, group therapy, telephone or Skype, consultations and any advice or information given, being all verbal, written and/or electronic, mechanical, photocopying, recording or other media including but not limited to that displayed on Purify Essential Wellness brochures, emails, oracle cards or books, promotional material, promotion at markets and fairs, on the website, TED talks, Instagram, Facebook or other social media or in any form of media, by Purify Essential Wellness, their employees, subcontractors and agents (“Services”). 

You agree to honestly and completely inform Purify Essential Wellness and keep Purify Essential Wellness informed at all times of all Health Information or change in circumstances whatsoever, You are obtaining Services of your own free will and consent to the Services from the date of your Initial consultation or purchase.

3. Fees and Cancellation

You agree to pay Purify Essential Wellness’ consultation fees and product fees. Fees include GST and are payable at the time of consultation unless otherwise agreed. Please give a minimum of 24 hours notice for any cancellations or a fee of $50 must be applied. 

4. Privacy Policy and Confidentiality

Test results or further information may be requested to be collected from You or Your other health professionals and a copy kept in our records. The Health Information collected about You will remain the property of Purify Essential Wellness as part of case history records. Purify Essential Wellness can be contacted on (02)99991641 should You wish to update such information. 

Purify Essential Wellness agree to keep the Health Information confidential save and except for the purposes of the provision of Services or otherwise as required or permitted by law, for obtaining legal advice or to comply with legal or regulatory requirements. 

5. Informed consent for Services and Disclosure and Limitation of Liability

You declare that all information provided by you is true and correct and You indemnify Purify Essential Wellness for any liability for any false or misleading statements given. 

You understand and accept that the Services received are holistic and do not attempt to diagnose or treat disease.  You also understand and accept that the tests performed by Purify Essential Wellness are not diagnostic. The Services often involve You taking herbal medicine or other nutritional supplements, undergoing oracle card and clairvoyant readings, Reiki, Skincare, Beauty Treatments, Therapeutic Massage, Circulatory Massage and spiritual healing sessions. This may result in You undergoing changes on emotional, mental, spiritual and physical levels. 

Anne-Maree Zofrea, Rebecca Comer, Lisa Clark, Tracey McConnell and all practitioners at Purify Essential Wellness, as a member of their appropriate Professional Associations will comply with their Code of Conduct and Ethics. 

The Services are not and it has not been represented to You by Purify Essential Wellness that the Services are a cure for any existing injury, allergy or other ailment whatsoever and that You have not been advised to discontinue any current treatment prescribed by any other person. 

You agree that You have provided full and frank disclosure to Purify Essential Wellness and that there has been no failure on your part to disclose any information. You acknowledge that the failure to provide any information by You may result in prescription of nutrition, supplementation or herbal medicine that could interact poorly with other medication, ailments, conditions or allergies.  

You have been informed by Purify Essential Wellness that every treatment is different and there are different sensations, feelings, emotions and responses that may be experienced in and following the Services. If You have any concerns telephone Purify Essential Wellness immediately on (02)99991641.

You acknowledge that you will inform Purify Essential Wellness immediately of any disease process that you may be suffering from, if you are pregnant, suspect you are pregnant, are attempting to become pregnant or if you are breastfeeding, suffer a mental illness or diagnosis requiring prescription medication / hospitalisation or any infectious disease. 

You are informed that in the giving of the Services, You may be given information from Spirit. You are informed and understand the opinions, advice or information provided is not that of Purify Essential Wellness and Purify Essential Wellness is not responsible for any reliance placed upon such opinions, information and advice. You should not rely on it and You should follow your own intuitive guidance to make your own decisions and take action based on your own free will choice.  

Herbal medicine takes approximately 6 weeks for the full benefit of the herbs to be integrated into the human body and that it is generally necessary for a follow up treatment at that time. In the interim if You have any concerns telephone Purify Essential Wellness immediately on 99991641. 

Alternative medicine is a form of primary health care that uses natural substances and treatments to support and stimulate the body’s ability to heal itself. Some complications that can occur include but are not limited to aggravation of pre-existing or existing symptoms, allergic reactions (for example to supplements or herbs), headaches, tingling and twitching, a feeling of heat or cold in the body, excessive strong smelling sweat, thirstiness, gastric or vomiting. You do not expect Purify Essential Wellness to be able to anticipate or explain all risks and complications. 

You acknowledge that You have been informed of and understand the Services Fees, expected benefits, potential risks and side effects.

6. Risk Warning and Liability Exclusion

You understand You are not seeing a medical doctor and Purify Essential Wellness’ intention is to provide general information and promote understanding to enhance your mental, emotional, physical and spiritual wellbeing, not provide or replace medical advice you may be receiving from other licensed health care providers and Purify Essential Wellness assumes no responsibility for your choices or actions following your consultation.

Purify Essential Wellness will provide a website which will contain general advice and information prepared by either Purify Essential Wellness, their employees, subcontractors and agents or a third party (“Third Party”). All advice is not tailored to You and if You follow any advice or information contained on the website You do at your own risk. The author of the advice will be specified on the website. You agree Purify Essential Wellness is not responsible or liable for the opinions or advice expressed in articles on the website written by the Purify Essential wellness, their employees, subcontractors or agents or the Third Party and neither the Third Party or Purify Essential Wellness or their employees, subcontractors or agents are responsible or liable should You follow the advice and You to the full extent permitted by law release, indemnify Purify Essential Wellness, their subcontractors, employees and agents and the Third Party as set out below. 

You agree that Purify Essential Wellness as a supplier of services and their subcontractors, employees and agents take measures to ensure the Services are as safe as possible, there is a risk that You could be personally injured as a result of the services. You understand that personal injury may result from the services and agree that You consent to the services at Your own risk.


You agree that Purify Essential Wellness, it’s agents, subcontractors and employees will not be liable to You or Your dependants for personal injury or death suffered by You or any accident, damage, injury, loss to the person, loss of property, loss of use of property, damage to property and/or pain and suffering arising from the Services due to:


1. Services not being supplied with due care or skill or not being reasonably fit or heraldry for their purpose or for breach of any other consumer guarantees applied by the Australian Consumer Law of this state; and/or


2. negligence, breach of contract and/or breach of statutory duty of Purify Essential Wellness.


You agree that You will indemnify Purify Essential Wellness, it’s agents, subcontractors and employees for and against all liability to You or Your dependants, for personal injury suffered by You or any accident, damage, injury, loss to the person, loss of property, loss of use of property, damage to property and/or pain and suffering arising from the Services due to:


1. Services not being supplied with due care or skill or not being reasonably fit or heraldry for their purpose or for breach of any other consumer guarantees applied by the Australian Consumer Law of this state; and/or


2. negligence, breach of contract and/or breach of statutory duty by Purify Essential Wellness, its’ agents, sub-contractors and employees.

To the full extent permitted by law You:

1.Fully and forever release and discharge Purify Essential Wellness, their subcontractors, employees and agents from all claims, suits, costs, damages demands, rights of action, claim for compensation and all liability present and future (including the cost of defending or settling any claim or action) with respect to any accident, damage, injury, loss to the person, loss of property, loss of use of property, damage to property and/or pain and suffering arising from the Services or as set out in the above; and

2.Further indemnify and keep indemnified Purify Essential Wellness, their subcontractors, employees and agents from all actions, suits, claims, losses, costs, legal costs, damages and expenses pursuant to this document and the above matters set out above.  


You understand that this limited liability exclusion is not intended to exclude restrict or modify liability which cannot be lawfully excluded, restricted or modified; and You acknowledge that this exclusion is governed by the laws of the State in which it is signed. 

You acknowledge that all valuables brought by You into the Purify Essential Wellness premises must be kept on You at all times and Purify Essential Wellness will take no responsibility for lost or stolen items.

7. Statutory Liability

There are provisions in certain legislation that imply terms into contracts. Some can be contracted out of and some may not. This includes legislation implying services must be rendered with due care and skill, correspond in nature and quality, be free from an inherent defect and be fit for the purpose including but not limited to the Fair Trading Act NSW, the Trade Practices Act (Cth) and the Sale of Goods Act NSW (“the Acts”). 

Purify Essential Wellness agrees to use their best endeavours to provide Services appropriate for You. Despite the above to the extent permitted by law any provisions of any statue which imply terms into contracts for the provision of services for the benefit of You and which may be fully or partially contracted out of are excluded in this Agreement. 

In the event any or all of the implied terms set out in the paragraphs directly above cannot be excluded Purify Essential Wellness’ liability for breach of the implied terms shall be limited to resupply of the Services for a period of a month from the date of the breach. 

Subject to the provisions of the Acts You agree Purify Essential Wellness, their employees, subcontractors and agents are not liable in the event the services provided by Purify Essential Wellness, their employees, subcontractors and agents are not fit for the purpose required, do not correspond in quality requested, are not free from defects or are not rendered with due care and skill. 

8. Intellectual Property 

Purify Essential Wellness has worked hard to produce audio, visual, written, images and verbal content in provision of the Services. The information produced is an important asset to Purify Essential Wellness and we must ensure they are protected and not used without consent and when permission is granted it needs to be properly credited to Purify Essential Wellness. You acknowledge this and agree that all information and advice provided in the Services remain the intellectual property of Purify Essential Wellness at all times. Purify Essential Wellness claims all intellectual property rights including but not limited to all information contained in all Services. All rights to the Services are reserved. No part of the Services can be reproduced, stored or introduced into a retrieval system or transmitted in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) in any way, in whole or in part without the prior written consent of Pure In Heart Pty Ltd and Anne-Maree Zofrea except for personal use. 

Any advice or information given to you by Purify Essential Wellness (being all verbal, images, audio/visual, written and/or electronic media, photocopying, recording or otherwise including but not limited to that displayed on Purify Essential Wellness Brochures, Emails, oracle cards or books, promotional material, promotion at markets and fairs, on the website, TED talks, Instagram, Facebook, social media or in any form of media by Purify Essential Wellness. cannot be used without first obtaining the permission from Pure In Heart Pty Ltd and Anne-Maree Zofrea to do so or unless specifically authorised. 

You must attribute copyright ownership to Anne-Maree Zofrea or Pure In Heart Pty Ltd trading as Purify Essential Wellness for all authorised uses. This should be depicted with “©Anne-Maree Zofrea & Pure In Heart Pty Ltd trading as Purify Essential Wellness. Reprinted with permission.” 

10.GENERAL

Any clause, provision or portion of this document which is prohibited or unenforceable in any jurisdiction shall, as to that jurisdiction, be ineffective to the extent of that prohibition or unenforceability, without invalidating the remaining portion of the clause or other provisions of this document or affecting the validity or enforceability of that clause, provision or portion in any other jurisdiction. 

The non-exercise or delay in exercising any right under this document does not act as a waiver of the right. The parties to this document agree this document binds their executors, heirs and assigns. 

Each indemnity undertaken by a party pursuant to this document shall constitute an obligation of that party separate and independent from its other obligations under this document and survive and continue subsequent to performance of the document. 

All representations and warranties in the document shall survive and continue subsequent to this document. This document shall be governed by and construed in accordance with the laws of New South Wales. 

Any legal proceedings with respect to this document against any party, property or assets may be brought in the Courts of New South Wales and the parties agree to the non-exclusive jurisdiction of New South Wales.  

BY SIGNING OUR NEW PATIENT FORM OR PURCHASING OUR SERVICES OR PRODUCTS YOU AGREE TO ALL OF THE ABOVE  Copyright - Pure in Heart Pty Ltd