Client Profile Form

Thema has a beautiful team that makes sure that her clients are properly prepared for their sessions and their client profile remains current in our system.

This form allows for things to remain sychronized to provide the highest level of care.

If you are an existing client, you will complete this form ahead of time to have a record of the progress happening in between your sessions. If you are a new client, you will complete this form to create your client profile.

Your experiences during our sessions are confidential, and you have a right to view your client profile records upon written request. You can send an emailed request to info@thewombsauna.com or give our team a call at 1-888-576-WOMB(9662) for additional help.

Confidentiality is subject to the following exceptions:

• You instruct me to release information to other health care practitioners and/or other individuals, in writing.
• I am subpoenaed or otherwise legally obligated or reasonably allowed to do so (including circumstances where there is clear and imminent danger to yourself or another person).
• Your confidential client profile is kept in a secure location and is retained for 5 years after you end services, after which time all information will be destroyed in a proper manner.
• Your confidentiality is always subject to the usual exclusions dictated by state and federal laws and regulations.

Thema Azize Serwa and her Certified Womb Sauna Practitioners (CWSP), provide personal empowerment services and biopsychosocial healing sessions to support natural, non-invasive, and non-toxic healing experiences and coaching. Thema provides a description of her certifications and education here that have contributed to her scope of care.

I understand that Thema Azize Serwa or any CWSP, is not a licensed physician or coach, as their scope of care, at present, is unregulated and therefore, their services are not licensed by the state of Maryland. I understand it is my responsibility to maintain a relationship for myself with a medical doctor, mental health professional, or any other essential specialized health professional, if I so desire. I further understand that Thema Azize Serwa and any CWSP, is not trained to diagnose illness, make recommendations involving pharmaceutical drugs or surgery, or handle medical emergencies. I also understand that the statements and services offered have not been evaluated by the US Food and Drug Administration.

I hereby release, waive, acquit and forever discharge The Womb Sauna and Thema Azize Serwa, any agents, successors, assigns, personal representatives, executors, heirs and employees from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of acts or omissions by myself or by Thema Azize Serwa, as a result of the recommendations given or otherwise resulting from any booked sessions. I further declare and represent that no promise, inducement or agreement not expressed in this agreement has been made to me to sign this agreement. This agreement shall bind my heirs, executors, personal representatives, successors, assigns, and agents.

Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless The Womb Sauna and Thema Azize Serwa, from and against any and all claims or liability of whatsoever kind or nature arising, out of or in connection with, my session(s). 

SMS Consent Message:

By submitting, you agree to receive text messages at the provided number from The Womb Sauna. Message frequency varies, and standard message and data rates may apply. You have the right to OPT-OUT receiving messages at any time. To OPT-OUT, reply "STOP" to any text message you receive from us. Reply HELP for assistance.