Consent Form for Private Sessions Chosen Name * First Name Last Name Email * Please read carefully... * Please bring a notebook and writing thing, and anything else that will help you stay present. Fidget toys, pets, and crystals are welcome. Make sure you have privacy so you can feel safe to share vulnerably and we can stay focused. Please be seated and in a situation in which you can have your camera on and focus on the screen (I.e. not driving). Mia is not a mental health professional nor a healer. Mia is an educator and intends to provide skills, tools, vocabulary, and structures. Their method is their own, and all guidance is suggested. They are not able to diagnose nor give medical advice. Mia doesn’t guarantee results. You’ll get out of it what you put in. I have a 24-hour cancellation policy. By submitting this form, I acknowledge that I have carefully read, or have had read to me, and understand the above consent. I give my permission and consent to care by the practitioner, and I am fully aware of what I am signing. I intend this consent form to cover the entire course of guidance I have sought out through the practitioner, current and future. Submitting this form is my e-signature. I have read and agree to the above. Thank you!