Medical Educational Intuitive Mini-Reading Request and Consent For for Facebook Live/Regular event on Dr. Mona Lisa Facebook Fan Page/Instagram Live/or Zoom Event

By checking the box below, I hereby represent and agree as follows:

• I am over 18 years of age; or , I am the parent or legal guardian of the subject of the reading.
• I wish to obtain a Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram LIve/Zoom Event or Regular Fan-page Event.
• I am currently under the care of a physician or other health care practitioner. As a client of Dr. Mona Lisa Schulz, you agree to take complete responsibility for your physical and emotional health.
• I understand that no physician-patient relationship is established through my participation in Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Event, I understand that this reading is not psychotherapy.
• I understand that this Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Event is not medical diagnosis, medical treatment or medical advice; therefore I understand that this Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Even will not provide prescription, treatment or psychotherapy.
• A Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Even will not provide a cure for any disease whether emotional, physical or spiritual. Any information or guidance provided by Mona Lisa Schulz, shall not be construed as a prescription, a promise of benefits, a claim of cures, or a guarantee of results to be achieved. Mona Lisa Schulz makes no guaranties or warranties of any nature whatsoever related to Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Event.
• During A Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram LIve/Zoom Event or Regular Fan-page Event a list of available options or solutions may be described, but I agree that before undertaking any of these options or solutions, I will consult my physician or other health care practitioner whose care I am currently under.
• You, on your own behalf and on behalf of your heirs, personal representatives, guardians and any persons deriving their claims through you or on your behalf, hereby waive, release and hold harmless Mona Lisa Schulz and her agents from any and all claims, liabilities and damages of any nature or kind whatsoever, related in any way to the service provided by or through Mona Lisa Schulz.
• You also acknowledge and agree that the Mona Lisa Schulz is not responsible for the negligent or intentional acts or omissions of any third party or for any of your own actions or inactions, that the total liability of Mona Lisa Schulz is limited to the services purchased by you from Mona Lisa Schulz and that Mona Lisa Schulz will not be liable for any direct, indirect, special, incidental, consequential, or punitive damages.
• I have carefully read this form and fully understand its contents.
• I understand that Mona Lisa Schulz reserves the right to refuse to do a Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Event or end one at any time.
• I understand that by requesting and consenting to participate in a Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live /Instagram Live/Zoom Event or Regular Fan-page Event, my first name, age will be stated either in audio and/or in written form on The Dr. Mona Lisa Fan Page/Instagram Live/Zoom Event . The Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Event between you and Dr. Mona Lisa will appear on the Dr. Mona Lisa Fan-page/Instagram Live/Zoom Event either in audio or written form.
• I understand that by requesting and consenting to participate in a Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Event, the Medical Educational Intuitive Mini-Reading between myself and Dr. Mona Lisa will occur by me calling into a phone line, and that the entire contents of the Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Event will be heard and or accessible by the Facebook community/Instagram community/Zoom community/ and the internet at large.
• Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Dr. Mona Lisa/ML Inc], its affiliates and agents, to use my voice, image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to:
  • (a) Permission to interview, tape, or otherwise make a audio or written reproduction of me and/or record my voice;
  • (b) Permission to use my 1st name and age,
  • (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness.
• You agree to indemnify, hold harmless and defend, the Released Parties from and against, any and all claims, liabilities, damages and expenses of every kind or nature whatsoever arising out of or attributed, directly or indirectly, to your failure to disclose truthful, accurate and complete information relevant to the services provided by Mona Lisa Schulz.
• This Agreement contains the entire agreement between you and Mona Lisa Schulz and supersedes all prior agreements and understandings, oral or written, with respect to the subject matter hereof. If any term or condition of this Agreement shall be invalid or unenforceable to any extent or in any application, then the remainder of this Agreement, and such term or condition, except to such extent or in such application, shall not be affected thereby and each and every term and condition of this Agreement shall be valid and enforceable to the fullest extent and in the broadest application permitted by law.
• By checking the box below, you acknowledge that you have read, understand and agree to the terms and conditions above and voluntarily consent to participate in A Medical Educational Intuitive Mini-Reading on a Dr. Mona Lisa Facebook-Live/Instagram Live/Zoom Event or Regular Fan-page Event.
• This consent is given in perpetuity, and does not require prior approval by me.

To schedule a Facebook Live / Instagram Live Medical Educational Intuitive Mini-Reading request with Dr. Mona Lisa, please fill out the form below and click submit.