I have engaged Dr. Shivani Khetan’s professional assistance to avail sessions for one or more of the following services, including but not limited to: (i) Clinical Hynotherapy; (ii) Services for Mudita Studio; (iii) Tarot Reading/Tarot counselling; (iv) Expressive Art Therapy for Teenagers & Adults; (v) Self-esteem Coach; (vi) Relationship Counselling; (vii) Chakra Healing; (viii) Space clearing; (hereinafter referred to as “Service(s)”). I recognize that in the course of the Service(s), it may be necessary for me to disclose to her certain Confidential Information (as defined below). By engaging Dr. Shivani Khetan to provide me one or more of the Service(s), I agree to be bound by the following Confidentiality Policy. “Confidential Information” shall mean all such interactions that take place during the course of Services(s) provided by Dr. Shivani Khetan in-person or virtually and includes all communication between us, whether recorded or not, any scheduling or appointment notes, all session content records and any progress notes that she prepares during or after the sessions.
1. To use all Confidential Information shared by me during the course of Service(s) exclusively for providing the Service(s).
2. To disclose or otherwise use my Confidential Information in such manner as agreed herein.
3. To issue or release for publication any articles or advertising or audio recordings or publicity matter relating to the Service(s) which do not mention my name, unless prior written consent is granted by me. Dr. Shivani Khetan shall make such amendments to any such press release or public statement as are reasonably requested by me.
4. To disclose to her employees such Confidential Information shared by me during the course of Service(s) in connection with the Service(s) on a need to know basis.
5. Disclosure of such Confidential Information which is in Dr. Shivani Khetan’s sole discretion required to be:
6. I have been made fully aware of and I have consented to the following:
7. If Dr. Shivani Khetan is concerned for my wellbeing or that of others she shall be free to seek help for me outside the therapeutic relationship and in such an event she shall not be considered to be in breach of her confidentiality obligations undertaken herein.
8. I agree that the information Dr. Shivani Khetan provides me during the Services, including but not limited to written material, handouts and the methodologies applied are confidential and copyright information and/or trade secrets of her business. I agree not to disclose any such copyright information and/or trade secrets to any third parties without Dr. Shivani Khetan’s express written approval.
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