top of page


I request, and consent to receive, the service modalities and/or educational sessions from Val Cook at or any person delegated from this company (collectively called the Facilitator, to supply or assist in supplying services to me.


I am aware that the service modalities described are not invasive in nature and is not a medical procedure nor is it a substitute for professional medical, psychiatric or clinical counseling / treatment.


I agree to assume full responsibility for any medical condition, disclosed or undisclosed, any drug or alcohol use, or any serious mental or emotional problem that I may have.


I understand and acknowledges Val Cook  will not be liable legally or otherwise, for the advice or actions I may or may not undertake as a result of the service modalities described on or offered by Val Cook.


I understand that the facilitator will not disclose any of my personal information to anyone, without written prior consent. I give permission to Val Cook and / or business staff to contact me by phone if deemed necessary.


I have read the above consent. I have also had an opportunity to ask questions about its content, and by signing below I agree to the service modalities offered by Val Cook at . I intend this consent form to cover the entire course of treatment for my present concerns and for any future concern(s) for which I seek assistance for.


By Submitting below I verify I am over 18 years of age and I have read Val Cook's "informed consent" notice and understand its contents.


( Please copy & paste the following in the "message section below"
I verify I am over 18 years of age and I have read Val Cook's informed consent notice and understand its contents.  

Informed Consent

Name *

Email *

Message *

Your Verification was sent successfully!

bottom of page