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INFORMED CONSENT & ACKNOWLEDGEMENT I, the undersigned, acknowledge and consent to receive complementary wellness services from Pure Frequency, which may include: Frequency-based wellness sessions Energy balancing or biofeedback technologies Nutritional and lifestyle education or support Non-medical advice on wellness, emotional regulation, or detox practices I understand that: These services are not regulated under the Regulated Health Professions Act of Manitoba. Practitioners at Pure Frequency are not licensed medical doctors, naturopaths, dietitians, psychologists, or other regulated health professionals. These services are intended as complementary and supportive, not diagnostic or curative. I understand that it is my responsibility to consult with a qualified medical professional regarding any health concerns, symptoms, or changes in health status. VOLUNTARY PARTICIPATION & RISKS I acknowledge that my participation is voluntary and that I may withdraw at any time. I accept full responsibility for any outcomes resulting from my sessions, including: Temporary detox or emotional release responses Unanticipated changes in energy levels or mood Delays in seeking medical treatment I have not been advised to discontinue or adjust any prescription medication or treatment plan by any representative of Pure Frequency. LIABILITY RELEASE UNDER MANITOBA LAW In consideration of receiving services from Pure Frequency, I hereby release, waive, and discharge Pure Frequency, its owners, employees, contractors, and affiliates from any and all liability, claims, demands, actions, or causes of action arising out of or related to: Any physical, mental, or emotional impact of the services; Loss or damage to personal property; Any misunderstanding of the nature or scope of the services provided. This release is made in accordance with the applicable laws of the Province of Manitoba, and is intended to be as broad and inclusive as permitted under those laws. I understand that certain rights may not be waivable under Canadian law, including those related to gross negligence or duty of care, and this release does not attempt to waive any right that cannot legally be waived. CONFIDENTIALITY & PRIVACY I understand that all personal information shared with Pure Frequency will be handled in compliance with The Personal Health Information Act (PHIA) of Manitoba and applicable federal privacy legislation, including the Personal Information Protection and Electronic Documents Act (PIPEDA). I consent to the collection and use of my information for the purpose of providing wellness services and communicating with me about my care. ACKNOWLEDGEMENT AND SIGNATURE I have read this form thoroughly and understand its contents. I am signing this waiver freely and voluntarily. I confirm that I am 18 years of age or older, or have legal guardian consent to receive these services.

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