DISCLOSURE STATEMENT AS REQUIRED UNDER SB-215 FOR COMPLEMENTARY AND ALTERNATIVE HEALTH CARE PRACTITIONERS IN COLORADO

1. Tiffany Adams, Moss Alchemy LLC
2. 1275 Spruce St, Denver CO, 80220
3. 443-676-2193

As a Complementary and Alternative Health Care Practitioner, I am not licensed, certified or registered by the state of Colorado as a clinical healthcare professional. I am not a licensed medical physician, psychologist, or psychiatrist and do not diagnose, treat, or prescribe cures or remedies in the treatment of disease. The services I perform, whether in person, by mail or by phone, are at all times restricted to complementary and alternative health care services intended for the maintenance of the best possible state of holistic health and well-being. I am prohibited from performing surgery or any invasive procedure, administer or prescribe x-ray radiation, prescribe prescription drugs, use general or spinal anesthetics, administer ionizing radioactive substances, use a laser device that punctures the skin, perform enemas/colonics unless board certified, practice midwifery, practice psychotherapy, perform spinal manipulation, practice optometry, directly administer medical protocols to a pregnant woman or a person who has cancer, practice dentistry, set fractures, practice massage therapy, provide a conventional medical disease diagnosis or recommend the discontinuation of a course of care recommended by a Board Certified health care professional*.

I am also prohibited from treating children less than two years of age. In order to treat a child who is between 2-8 years of age, I must have a written, signed consent of the child’s parent or legal guardian:

The services I provide are as follows: Reiki, Energy Work, Life Coaching, Sound Alchemy, Tarot/Orachle Readings, and Intuitive Guidance.

My training, experience, credentials and qualifications are as follows:

Certified to Teach Vinyasa, Yin, Prenatal Yoga, Yoga Nidra, & Meditation March 2017.
Reiki: Reiki I June 2022, Reiki II July 2022 from Jeremy Wolf
Life Coaching: Certified Life Coach March 2024 with Lumia

I carry liability insurance through CPH Insurance which is applicable to any injury caused by an act or omission in providing complementary and alternative healthcare services. A copy of this disclosure statement will be kept on file for at least two years after the last date of service.

By signing this form you hereby give consent for Tiffany Adams, to administer opportunities for Reiki and Healing Touch, Intuitively Channeled Information, Mindfulness Suggestions, Sound Alchemy and Spiritual Guidance from the Date of First Visit and beyond. In the event of legal action, you hereby agree that this document proves original consent of the above and absolutely no other forms of healing unless otherwise certified and stated prior to action.

I understand that the Reiki and Energy Work I receive is provided for the basic purpose of relaxation and relief of tension and stress. If I experience any pain or discomfort during this session, I will immediately inform the facilitator so that adjustments can be made for my level of comfort.

I further understand that Reiki should not be construed as a substitute for medical examination, diagnosis, or treatment, and that I should see a physician or other qualified medical specialist for any physical or mental ailment that I am aware of. I understand that Reiki facilitators are not qualified to diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session should be construed as such.

I affirm that I stated all my known medical conditions and answered all questions honestly. I agree to keep the facilitator updated as to any changes in my medical profile and understand that there shall be no liability on the facilitator’s part should I fail to do so.

*As my client, you should discuss any recommendations I provide with your Primary Care Physician, Psychiatrist, Psychologist, Obstetrician, Gynecologist, Oncologist, Cardiologist, Pediatrician or Pediatric Health Care Provider, or other Board-Certified Physician.

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I, here by, permit the use of my written signature or electronic signature in place of a written consent in agreement to the above disclosure statements. *

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Terms & Conditions

1. You are 18 years or older or have consent from your legal guardian.

2. Tiffany Adams prides herself on honesty and integrity. While she conducts every reading, healing, and coaching session to the best of her ability, 100% accuracy is not guaranteed, and you may not hear what you are expecting to.

3. All intuitive, tarot, energy readings, and intuitive coaching sessions, and consultations with Tiffany Adams and/or Moss Alchemy LLC are for educational purposes only. This includes information obtained on www.MossAlchemy.com, and Tiffany Adams’s social media platforms.

4. No reading, healing, or coaching session given by Tiffany Adams and/or Moss Alchemy LLC is intended to, nor should it ever take the place of professional services including but not limited to: medical, legal, financial, business, psychological, therapy, and/or counseling.

5. Tiffany Adams, Moss Alchemy LLC nor www.MossAlchemy.com accepts no liability and/or responsibility for any actions or decisions any client chooses to take or make based on their reading, consultation, or session with Tiffany Adams and/or Moss Alchemy LLC as well as content created by Tiffany Adams and/or Moss Alchemy including but not limited to Instagram and blog posts.

6. Be advised that engaging in any of Tiffany Adams’s services or services by Moss Alchemy LLC including but not limited to readings, healings, intuitive coaching, group sessions and others, is not a relationship protected by legal confidentiality (like doctor-patient or attorney-client). As such, Tiffany Adams and Moss Alchemy LLC could be required to divulge otherwise confidential information to authorities or if you have the intention to harm yourself or others.

7. You agree to absolutely indemnify and hold harmless Tiffany Adams, their heirs, relatives, employees, subcontractors, agents, or assignees in perpetuity and throughout all known and unknown universes against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s). Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Tiffany Adams and Moss Alchemy LLC from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

8. Copyright and Confidentiality laws apply. You agree you will not publish, share, display, distribute, and/or archive any material, photo, video, content, etc without written permission from Tiffany Adams and Moss Alchemy LLC.

9. Social Media: You may share my content on appropriate social media outlets as long as appropriate attribution is given.

10. You have read and understand our Privacy Policy.

11. As a visitor of www.MossAlchemy.com and a person who engages with or reads information via social media platforms run by Tiffany Adams representing Moss Alchemy LLC, you understand that Tiffany Adams and Moss Alchemy LLC are not liable for fraudulent misrepresentation and/or any losses as a result of scams or appointments/readings which you booked and/or paid for outside of www.MossAlchemy.com.

12. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Tiffany Adams and Moss Alchemy LLC from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

13. All issues and controversies arising out of this Agreement shall be governed by the laws of the State of Colorado without regard to conflict of laws principles. The prevailing party in any litigation, arbitration or other dispute resolution arising out of this Agreement, Terms and Conditions, or otherwise relating to services provided by Tiffany Adams and Moss Alchemy LLC shall be awarded attorney fees and costs.

14. Payment Policies: One-on-one sessions may be canceled with a 100% refund as long as written notice is given 48 hours in advance and group programs may be canceled with 7 days notice. Any one-on-one session canceled or rescheduled without 48 hours notice and due to a non-emergency is subject to a 50% cancellation fee. Any group program canceled within 7 days before the first session is subject to a 50% cancellation fee. After completion, no-shows, and cancellations within 12 hrs are non-refundable/ Once purchased, all sessions, gifts, packages, and group programs are non-refundable and their value may only be used towards credit. If for whatever reason, Tiffany Adams cannot fulfill the session, you will receive a refund for the amount unused. Upon your purchase, all terms are agreed to.