Liability Form Liability Form Please read carefully prior to your initial visit with Karen Korona. Karen Korona, M.S. Holistic Healer and Spiritual Counselor 303-725-1119Service and Fees:2 Hour Initial Consultation & Healing Treatment ~ $325.00 90 Minutes Session ~ $275.001 Hour Session ~ $185.00Office Hours:Monday through Thursday 9:00am - 6:00pmPayment and Cancellation Policy:All payments are requested in full at the time of your visit. You may pre-pay via the website with a credit card prior to your appointment, or via check or cash at the time of your appointment. All cancellations require 24 hour notification. Since time is reserved for your scheduled appointment, you will be charged for your appointment unless you have notified us 24 hours prior to your scheduled appointment. Insurance Reimbursement:It is our experience that most insurance companies do not cover Holistic Health Therapies. However, if your insurance company will reimburse your for these services, a statement will be provided to you for submission to your insurance company. You can contact your insurance company or employer to ascertain if these services are covered. Please remember that this is your responsibility to interact with your insurance company. Patient Commitment/Agreement:I acknowledge that I am enrolling in a holistic health and self healing program with Karen Korona, M.S., which included the following services: Touch-Healing Treatments, Craniosacral Therapy, Spiritual Counseling, and Nutritional Education. I understand this is an educational program, and that I am reliable for my success in the program, which requires my responsibility and commitment to my own healing. By checking these boxes and submitting this form you acknowldege you have read and agree to these terms prior to working with Karen Korona* I understand and agree to the Services and Fees for which I am scheduling my appointment I understand the Payments & Cancellation Policy I understand the Patient Commitment/Agreement I understand that Insurance Reimbursement is my Responsibility Name First Last Date