Kari Uselman, Ph.D.

Wellness Essentials, LLC

Waiver Form

I understand that the attending qualified biofeedback practitioner specializes in EPFX/SCIO biofeedback. She has been trained through the Quantum Alliance under the umbrella of the Neurotherapy and Biofeedback Certification Board, and has attended advanced training with William Nelson, PhD, Steven Small, MD, Paul Drouin, MD/PhD, Susan Blackard, PhD/RN, Faith Nelson, PhD/RN, Bill Cunningham, PhD., Ginger Bowler, PhD,and Levi Baxa, BFS. Kari Uselman, PhD takes ongoing continuing education courses through the International Quantum University of Integrative Medicine and the Quantum Alliance. Her practice includes biofeedback, craniosacral therapy, energy medicine, homeopathy, and wellness education.

I fully understand that Kari Uselman, PhD is not an allopathic doctor (MD), that she does not portray herself as such, and that the services provided are behavioral, energetic, and/or biofeedback in nature. I understand that allopathic drugs, radiation, chemical stimulants, and surgery are not offered. In addition, Kari Uselman, PhD does not diagnose, treat, or prescribe for any disease or illness, or perform any act that constitutes the practice of medicine for which a medical license is required. I understand that the attending practitioner facilitates her services within the parameters of a natural health care and wellness system using Biofeedback and stress reduction specialties.

I understand that Kari Uselman, PhD is a doctor of philosophy and education. She has over 15 years experience in reading, language, learning disabilities, and wellness which she weaves into her healing practice. In addition, Kari has studied and participated in wellness education programs and practices for over 20 years including homeopathy, flower essences, yoga, meditation, Tibetan Rites of Rejuvenation, Christ Touch, and Reiki. Kari is a craniosacral practitioner trained through the Upledger Institute founded by John E. Upledger, D.O./O.M.M. Her craniosacral skills include advanced techniques in TMJ and release of trapped energy cysts in the body. Kari is a Reiki Master teacher, certified in the Usui Reiki Method, and has been facilitating mind, body, spirit energy healing for over 10 years. She is also certified in Pilates, and is currently working on advanced training in natural medicine through the International Quantum University of Integrative Medicine.

I have requested the attending practitioner’s services in good faith, exercising my free will and following the dictates of my own conscience, which allows me to select what I understand to be most beneficial for my heath. If I desire any services not provided by the attending practitioner, I fully understand that I could seek them elsewhere. I am fully aware and release the practitioner to run biofeedback stress reduction protocols and perform craniosacral therapy and energy medicine techniques. By signing below, I acknowledge that I have read and understand all parts of this waiver, that I had the opportunity to ask questions regarding my session(s). I hereby affirm: I am not here for medical, diagnostic, or treatment procedures for this visit and any subsequent visits. I am here for the services Kari Uselman, PhD offers, and presently seek biofeedback, and other programs and services within the scope of the attending practitioner for stress reduction, relaxation, wellness, and pain management. I agree that I am receiving suggestions to improve my health. It is my choice and responsibility to improve my health.

I release Kari Uselman, PhD, Biofeedback Practitioner, Craniosacral Practitioner, Reiki Master Teacher, and educator, to analyze stressors, run Biofeedback programs, and facilitate stress reduction.

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First Name: ______Middle: ______Last: ______Maiden: ______

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