Digital Consent

Digital Consent Form

Download a Word Document and sign a physical copy of our Qigong consent form or submit it online below:

Ellie Dolgin
Water Wheel Arts, LLC
Certified Qigong Instructor
Santa Fe, NM and Denver, CO

Informed Consent for Qigong Instruction

I, the undersigned, understand that qigong instruction, whether online or in person, is not meant to diagnose, treat, or cure any illness, pain or ailment and is not a substitute for medical, psychological or nutritional diagnosis, attention or treatment. I agree to inform my instructor promptly if any postures become painful or feel precarious.

Any information shared by Ellie Dolgin about emotional or organ systems are described in the context of Chinese understandings of the body and, even though they may include words about health or body systems, they are not equivalent to such terms from a western medical perspective and are by no means meant to serve as a replacement for diagnosis or treatment from a medical doctor or psychological practitioner.

I realize that it is my responsibility to notify my instructor of any serious illness, injury or change in health status and cease to perform any movements that exceed my physical ability or mental state. I accept that neither my instructor nor the venue is liable for any injury or damages to person or property resulting from my participation in a class.

All audio and/or visual recording of teachings are prohibited. These forms are to be transmitted directly from teacher to student. I agree to abide by these terms.
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Informed Consent for Qigong Instruction

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