Agreement for Wellness Services | Brigitte Factor Agreement for Wellness Services | Brigitte Factor

Brigitte Factor, D.PSc, is a pastoral health and wellness provider, licensed in such capacity by the Pastoral Medical Association (PMA) and is required to provide certain disclosures to you and before providing services, to have on-file an agreement for services that provides clear and specific terms and conditions of the relationship. The Agreement below meets these requirements.

In this Agreement, Brigitte Factor is referred to as “Practitioner”, you are referred to as “Client”, the term “Party” refers to an indicated party to the Agreement, and the term “Parties” refers to Practitioner and you jointly.

Please read this Agreement carefully and indicate your acceptance of its terms by completing the form on the right. You will be emailed a copy of this signed agreement.

Complete this form


COMPLETE OUR AGREEMENT FOR WELLNESS SERVICES

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If you do not have an email address, please provide the name of someone authorized to communicate by email on your behalf to whom we can send a copy of this Agreement.
Name of Person Authorized to Receive/Send Email on Client's Behalf The Person's Email Address
Phone

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