INFORMED CONSENT
Experiences with Joanna Tholstrom guide + support deep self exploration and transformation in the physical,
mental, emotional, spiritual, and energetic body through a variety of ancient and modern practices. The powerful
tools and modalities used in practice with Jo create experiences felt in varied levels of consciousness.
Because these experiences can bring up intense emotions and strong physical experiences, I understand that issues
arising from my participation may require additional therapeutic or supportive interventions. These experiences have
the potential to create both desirable and undesirable effects.
If you are pregnant, taking anticoagulant drugs (ex. Coumadin), have a severe bleeding disorder (hemophilia), have
a heart condition, diabetes, circulatory problems, blood clots, cancer/malignancies, bone disorders (osteoporosis/
Paget’s disease/multiple myeloma), any serious medical condition, metal implants or a pacemaker, please make this
information known to me prior to your treatment.
I acknowledge that I am voluntarily participating in breath-work based, meditative movement and energetic
experiences with Joanna Tholstrom.
I understand that any coaching I experience does not involve the diagnosis or treatment of mental disorders as
defined by the American Psychiatric Association. I understand that coaching is not a substitute for counseling,
psychotherapy, psychoanalysis, mental health care or substance abuse treatment.
I acknowledge and understand that I am responsible for all aspects of my health and well-being. I further recognize
and understand that the instructions and advice presented to me are in no way intended as substitutes for medical
and/or other professional counseling. If I have any health concerns that may interfere with my participation, I
understand that I should consult my healthcare provider before beginning the meditation and movement exercises,
and should inform Joanna Tholstrom. If I experience pain or difficulty that is cause for concern during or after
practicing the exercises, I understand that I should stop immediately and consult my healthcare provider before
continuing on.
I recognize, understand, and assume all risks associated with my voluntary participation, including, but not limited
to, those risks that may result in personal injury and death. In giving my informed consent to participate, I hereby
release Joanna Tholstrom and Embodied Emotions, LLC. from any and all claims, now or in the future, that I may
have as a result of my voluntary participation in the services of Joanna Tholstrom.
24 hours notice policy for cancellations or changes of scheduled appointments. Less than 24 hours notice will result
in a charge applied at discretion of Jo, and not to exceed total session price.
All information that you share will be held as confidential, unless there is considerable concern for your safety or the
safety of another individual. It is your responsibility to let me know if there are any specific goals or topics you
would like to discuss or explore or health conditions I should be aware of.
I do hereby consent to the use of my image, video, voice, or all three of them, for the use of Embodied Emotions,
LLC., as well as for the use of Essential Emotions, LLC. In addition, I waive any right to inspect or approve the
finished video recording.
Payment is due in full at the time of service for both services and products.