Client Disclosure, Health Freedom Notice & Informed Consent

1. Disclosure Statement – Ayurvedic Wellness Services

(California Senate Bill 577 – Health Freedom Law)

Practitioner Name: Dr. Tinsa Simon

Business Name: Ayurway

Location: 463 Kilkare Rd Unit 3, Sunol, CA 94586

I understand and acknowledge that the practitioner(s) at Ayurway are not licensed physicians or surgeons and are not licensed to practice medicine in the State of California.

Ayurway operates under California Senate Bill 577 (Health Freedom Law) and provides Ayurvedic wellness services and traditional health education only.

Nature & Scope of Services

The services provided by Ayurway may include, but are not limited to:

Ayurvedic lifestyle and wellness consultations
Traditional dietary and nutrition guidance
Education regarding Ayurvedic herbs, oils, and traditional formulations
Non-medical bodywork, relaxation, or rejuvenation therapies
Stress-reduction, detoxification, and wellness education

These services are educational and wellness-oriented and are not intended to diagnose, treat, cure, or prevent any disease or medical condition.

Medical Disclaimer

I understand and acknowledge that:

Ayurway does not provide medical diagnosis, prescribe pharmaceutical medications, or perform medical procedures
Ayurway does not advise discontinuation of prescribed medications or medical treatment
Ayurway services are not a substitute for licensed medical care
I am encouraged to consult a licensed physician or healthcare provider for medical conditions, symptoms, or emergencies

Practitioner Education & Training

Practitioners at Ayurway are trained in traditional Ayurvedic education, wellness practices, and holistic health systems, which may include formal coursework, lineage-based study, certifications, and ongoing education.

These credentials are not equivalent to medical licensure in the State of California.

2. Assumption of Risk & Limitation of Liability

I understand that participation in Ayurvedic wellness services, including lifestyle changes, dietary recommendations, herbal education, and non-medical body therapies, involves inherent risks, including but not limited to:

Temporary discomfort
Detox or cleansing reactions
Skin sensitivity or allergic reactions
Muscle soreness, fatigue, or emotional release

I voluntarily assume all risks associated with receiving Ayurvedic wellness services.

I acknowledge and agree that Ayurway, its practitioners, employees, and affiliates shall not be held liable for any injury, illness, adverse reaction, or outcome that may occur as a result of participation in Ayurvedic services, except in cases of gross negligence or willful misconduct as defined by law.

3. Client Responsibilities

I understand that I am responsible for:

Providing accurate and complete information regarding my medical history
Disclosing known medical conditions, allergies, pregnancy status, injuries, or medications
Communicating any discomfort or concerns during services
Seeking medical attention when necessary

4. Informed Consent – Ayurvedic Wellness Services

I voluntarily choose to receive Ayurvedic wellness services from Ayurway.

I understand that:

Ayurvedic services are traditional, complementary, and educational in nature
Individual results vary and no guarantees are made
I may decline or discontinue services at any time
I am free to pursue licensed medical care at any time

I confirm that I have read, understood, and voluntarily consent to receiving Ayurvedic wellness services with full awareness of their scope, limitations, and risks.

5. Acknowledgment & Signature

I acknowledge that I have read and understand this Client Disclosure, Health Freedom Notice, Assumption of Risk, and Informed Consent.

Download file for Signature