ÌTỌ́NA — Destiny Alignment and Life Guidance
Client Informed Consent and Services Agreement
ÌTỌ́NA is a program of Medicinal Gourds LLC offering destiny alignment, life guidance, relationship guidance, personal development, spiritual consultation, and educational support.
For this agreement, “Provider” means ÌTỌ́NA, Medicinal Gourds LLC, Awo Èṣùdámílárẹ̀, and every authorized staff member, independent contractor, practitioner, facilitator, consultant, or life guide providing services through ÌTỌ́NA.
1. Nature of Services
ÌTỌ́NA provides guidance to individuals, couples, and families seeking clarity, direction, balance, personal growth, stronger relationships, purposeful decision-making, and a deeper connection with the greatness within.
Services may include guided reflection, deep listening, personal-development practices, relationship guidance, goal-setting, accountability, spiritual insight when requested, and practical recommendations.
Each practitioner will clearly identify their role, background, experience, and the type of guidance they provide.
2. Voluntary Participation
I understand that my participation is voluntary. I may ask questions, decline a recommendation, pause a session, request another available practitioner, or discontinue services at any time.
I understand that guidance may invite honest reflection and personal responsibility. I remain responsible for deciding whether and how to apply the information or recommendations discussed during my sessions.
3. Client Responsibility
I understand that ÌTỌ́NA and its practitioners do not make decisions on my behalf or guarantee a particular personal, spiritual, relationship, career, financial, or life outcome.
I accept responsibility for my choices, actions, relationships, finances, health decisions, and the results of decisions I make following a session. I agree to provide information that is accurate and complete to the best of my knowledge.
4. Privacy and Confidentiality
ÌTỌ́NA will treat information shared during sessions with care and respect. Information will only be shared among authorized ÌTỌ́NA personnel when reasonably necessary to coordinate or provide services, maintain business records, or protect the client or another person.
Privacy may be limited when disclosure is required or permitted by law, including:
- Suspected abuse, neglect, or exploitation of a child, elderly person, or person with a disability;
- A serious or immediate safety concern involving the client or another person;
- A valid court order, subpoena, or other legal requirement;
- A payment dispute, complaint, legal claim, or proceeding in which information is reasonably necessary to protect the rights of the client, practitioner, or Provider; or
- A situation in which the client provides written permission to release information.
When disclosure is necessary, the Provider will make a reasonable effort to disclose only the information required for the specific purpose.
ÌTỌ́NA cannot guarantee the privacy of ordinary email, text messages, social media messages, or conversations conducted in public or shared spaces.
5. Couples and Family Guidance
When services involve a couple or family, the relationship or family unit may be treated as the client for purposes of the guidance process.
Participants agree to communicate respectfully and understand that information shared privately with a practitioner may affect the joint guidance process. Before beginning services, the practitioner and participants will discuss how private disclosures will be handled.
Each adult participant must sign this agreement unless the Provider approves another arrangement in writing.
6. Services for Minors
A parent or legal guardian must provide written consent before a minor receives individual services through ÌTỌ́NA. The parent or guardian remains responsible for the minor's care, transportation, safety, and participation.
The practitioner will explain the appropriate level of privacy between the minor and parent or guardian while following applicable safety and reporting requirements.
7. Emergencies and Immediate Safety Needs
ÌTỌ́NA sessions are scheduled guidance services and are not an emergency-response service. If an immediate safety concern arises, I authorize the Provider to contact emergency services, my emergency contact, or another appropriate resource when reasonably necessary to protect life or safety.
Emergency contact name:
Relationship:
Telephone number:
8. Appointments, Fees and Cancellations
Session fee: $
Session length:
Payment is due:
Cancellation or rescheduling policy:
Any package, refund, late-arrival, or missed-appointment terms will be explained before payment is accepted.
9. Records and Communications
ÌTỌ́NA may maintain scheduling information, payment records, signed agreements, practitioner notes, and other information reasonably necessary to provide and document services.
I understand that appointment reminders and general administrative information may be sent by telephone, text message, or email using the contact information I provide.
Preferred contact method:
Telephone number:
Email address:
I authorize appointment and administrative communications through the contact method selected above.
Client initials:
10. Working With Other Professionals
ÌTỌ́NA may recommend assistance from an appropriate medical, mental-health, legal, financial, or other professional when a client's needs extend beyond the role, training, or experience of the practitioner providing guidance.
The Provider may coordinate with another professional when I provide written permission, except when disclosure is required or permitted by law for safety or legal compliance.
11. Practitioner Assignments
I understand that services may be provided by Awo Èṣùdámílárẹ̀ or another authorized ÌTỌ́NA practitioner, facilitator, consultant, contractor, or life guide.
I will be informed of the name and role of the person providing my services. I may ask questions about that person's background and experience before agreeing to receive services.
Assigned practitioner or life guide:
Practitioner's role or title:
12. Concerns and Complaints
I may raise questions or concerns directly with my practitioner or contact ÌTỌ́NA management at:
Telephone:
Email:
Mailing address:
ÌTỌ́NA will make a good-faith effort to address concerns respectfully, promptly, and fairly.
13. Limitation of Responsibility
To the extent permitted by law, I understand that the Provider is not responsible for outcomes resulting solely from my independent decisions, actions, omissions, failure to disclose relevant information, or failure to obtain additional professional assistance when recommended.
Nothing in this agreement removes any right or responsibility that cannot legally be waived.
14. Entire Agreement
This agreement explains the general understanding between the client and the Provider concerning ÌTỌ́NA services. Any changes must be made in writing and accepted by both the client and an authorized representative of the Provider.
If one part of this agreement is found to be invalid or unenforceable, the remaining portions will continue to apply to the extent permitted by law.
15. Acknowledgment and Consent
By signing below, I confirm that:
- I have read and understand this agreement;
- I have had an opportunity to ask questions;
- I understand the role and type of services being offered;
- I understand the privacy and reporting limitations;
- I voluntarily consent to receive services from ÌTỌ́NA and its authorized practitioners;
- I understand that I remain responsible for my decisions and actions; and
- I understand that this agreement applies to ÌTỌ́NA, Medicinal Gourds LLC, Awo Èṣùdámílárẹ̀, and every authorized staff member, contractor, practitioner, facilitator, consultant, and life guide providing services through the program.
Client's printed name:
Client's signature:
Date:
Practitioner's printed name and title:
Practitioner's signature:
Date:
For a Minor
Minor's printed name:
Parent/legal guardian's printed name:
Parent/legal guardian's signature:
Date:
For Couples or Family Guidance
Additional participant's printed name:
Additional participant's signature:
Date:
Questions about this agreement? Email medicinalgourds@gmail.com or call 512-383-6338.