The following consent and indemnity is required prior to the provision of therapy:

1. THE PRACTICE

The Practice means the Therapeutic Reflexology private practice of Christo A. Scheepers.

2. TERMINOLOGY

The term patient in this Terms and Conditions document also includes the term client.

3. ACCEPTANCE AND TERMS OF PAYMENT

The undersigned, patient (the term includes client), responsible person, parent, legal guardian, or surety of the patient hereby assumes liability as the principal debtor, alternatively as co-debtor jointly and severally with the patient, for the payment of any claims by The Practice arising from services rendered to the patient, or to be rendered to the patient, notwithstanding the existence of a medical aid fund or insurance covering such claims. Any person who signs this document in any of the capacities described above, confirms that: (1) he/she is aware that invoice/statements are delivered directly to his/her email address, unless no email address is available, in which instance the postal services will be used at own risk; (2) he/she is appraised of the tariffs charged by The Practice; medical aid rates apply; (3) he/she is aware that The Practice is contracted out of medical aid and therefore The Practice is not liable for the submission of medical claims with any medical fund; (4) he/she is responsible to settle the consultation/therapy cost directly after the treatment by means of any of the available payment methods and then personally claim back from his/her medical aid; (5) he/she is aware that reimbursement by medical aid is possible, but only if his/her medical aid and the specific plan/option he/she is on, covers therapeutic reflexology treatment; (6) he/she is aware that it is his/her own responsibility to determine if his/her medical aid and specific plan/option covers therapeutic reflexology and if reimbursement is possible; (7) he/she will settle any accounts or outstanding amounts within 30 days after receipt thereof; and (8) he/she will notify The Practice within 14 days after the treatment date if he/she has not received an account.

4. BREACH OF CONTRACT

In the event where any of the undersigned parties described in clause 2 above commits a breach of contract, The Practice is immediately entitled to enforce all its contractual remedies. The undersigned specifically agree that any breach of the terms of payment described in clause 3 will constitute a material breach of contract. The undersigned understand that two (2) percent (%) interest will be calculated monthly on all outstanding bad debt accounts and then be handed over to our debt collectors.

5. GENERAL

The Form of Admission constitutes the whole and entire agreement between the parties and there have not been and there are no agreements, representations, or warranties between the parties other than those specifically set forth herein. No variation, modification or cancellation of this agreement shall be of any legal force or effect unless the same shall be confirmed in writing and signed by all parties involved.

6. JURISDICATION

This agreement is subject to and shall be interpreted and construed in terms of the laws of the Republic of South Africa and is subject to the jurisdiction of a competent court in the Republic of South Africa. The parties agree that this agreement does not fall within the jurisdiction of the National Credit Act of 2005.

7. PERSONAL INFORMATION

The undersigned, patient, responsible person, legal guardian, or surety of the patient, hereby authorises The Practice to collect, share and exchange credit information concerning them with any credit bureau or any other person or corporation with whom they may have had or may have financial dealing, as well as, where applicable, other information requested pursuant to, or in any circumstances contemplated in the National Credit Act, Act 34 of 2005. The Practice complies with the Protection of Personal Information (POPI) Act, Act 4 of 2013, and will not share or sell other personal information with third parties unless ordered to do so by a court of law.

8. PERSONAL THERAPEUTIC (ICD-10 CODE) INFORMATION

The Practice is given the right to disclose personal medical (therapeutic) information such as ICD-10 therapeutic codes and clinical information pertaining to the patient on all invoice/statements and to its legal representatives or debt collectors provided that such information is treated as confidential and in good faith and only insofar as it is necessary for debt collecting purposes.

9. DOMICILIUM

The parties choose the domicillium citandi et executandi at the address shown on the overleaf.

10. LEGAL COSTS

Should The Practice commence legal proceedings, the patient undertakes to pay all legal costs relating to the recovery of the outstanding monies in respect of professional services rendered, including attorney fees on an attorney-own-client scale, collection fees and commission, interest and tracing costs.

11. MAILING LIST

The undersigned consent to become part of the Christo Scheepers Therapeutic Reflexologist mailing list to receive updates about The Practice and relating newsletters from time to time and understand that he/she will never be spammed or harassed with constant emails.

12. PHOTOS

The undersigned consent to the taking of photos of his/her feet, hands, arms, legs, ears, back (where applicable) and face (for the medical file profile picture only), and for the storage thereof in his/her medical file and consent for the photos to be used in a professional manner on The Practice websites, presentations and material, conditional of the fact that he/she will be fully anonymous, never be identified nor have facial recognition in any photo as to ensure anonymity and professionalism.

13. LEGISLATION

Therapeutic Reflexology is a complementary healthcare modality that is professionally regulated by the AHPCSA in accordance with the Allied Health Professions Act, Act 63 of 1982.

14. UNDERSTANDING OF THERAPEUTIC REFLEXOLOGY

The undersigned confirms that the following is understood about therapeutic reflexology: Reflexology is a modern Western therapy in which pressure is applied to distinct areas of the feet (reflexes/nerve endings), but sometimes also other body parts. There are body meridians spanning across the entire body and during body reflexology, reflex (nerve ending) stimulation is carried out along these meridians. The stimulation is usually done through physical touch by making use of finger pressure, sometimes unregulated massage (body rub) techniques to warm up the muscle before stimulation, and sometimes the Vacuflex Concepts electronic reflexology suction cups (that may leave blue/colour marks on the body that may last for a few weeks). Reflexology is a non- invasive art and science; it is a very effective form of therapeutic foot massage and seen as a niche and one of the most popular modalities in the field of complementary and alternative medicine. Reflexology is a science because it is based on physiological and neurological study, but it is an art because much depends on how skilfully the therapist applies his knowledge. When the body is out of balance it is not functioning effectively. By stimulating the reflexes on the feet, an involuntary response is produced in organs and glands connected by energy pathways to these specific reflexes. This sets a chain reaction in motion, which causes physiological changes to occur throughout the body systems. Anyone can benefit from Reflexology treatments, regardless of age or gender. However, caution is taken with: (1) Those suffering from thrombosis or internal bleeding as blood circulation could increase; (2) Insulin-dependent diabetics as stimulation of the pancreas could increase insulin levels; (3) Pregnant females (particularly during the first trimester); and (4) Sufferers of phlebitis, lymphatic cancer, leukaemia, osteoporosis, and epilepsy. The effects of Reflexology may not be capable of removing the cause of terminal diseases, such as cancer, multiple sclerosis, and Aids, but the person can be made more comfortable and the pain bearable. It can significantly improve the patient’s general condition, activate excretory organs, stimulate the respiratory system, and assist in better control of the bladder and bowels. In this way, Reflexology treatments can improve the quality of life. Reflexology is one of the best methods to reduce stress which is seen as the cause of 85% of all known disease in modern society. As with any other healthcare modality, there are no guarantees that therapeutic reflexology will work for the specific reason the patient receives treatment and it is understood that each person’s body will react differently to treatment.

15. SCOPE OF PRACTICE

Reflexologists do not diagnose, treat a specific disease or illness, interfere with medication, or prescribe medication. If you have a specific medical problem or complaint, you are advised to seek professional medical help. You should also discuss any problems or complaints with the therapist if you are unsure whether or not to continue with treatment for whatever reason. The Therapeutic Reflexologist functions within a professional scope of practice as provided by the Allied Health Professions Council of South Africa (AHPCSA).

16. COMBINATION TREATMENTS

As per Statutory Council legislative and regulatory requirements, any treatment falling outside the Therapeutic Reflexology Scope of Practice, may not be performed as part of the Therapeutic Reflexology Consultation. To comply with Statutory Council legislative and regulatory requirements, any treatments (for example bodywork therapy, or unregulated massage [body rub] as per the beauty and spa industry) falling outside the Therapeutic Reflexology Scope of Practice is performed at The Practice in a separate session than the Therapeutic Reflexology consultation (either as a stand-alone session or as an add-on session following or preceding the Therapeutic Reflexology session).

17. OWN REQUEST

The undersigned have read and understood the above terms and conditions and he/she is consenting to receive treatment by choice and at his/her own request and confirms that the information provided in the form of admission is true and correct.