Refund, Cancellation and Consent Form


Welcome to The Mind Veda!

To effectively provide counselling services and consultation, it is important for you (“Client”) to understand that the psychologist and psychiatrists of The Mind Veda (“Therapist(s)”) and the Client have certain rights and responsibilities towards each other as follows:

Declaration


By signing this document, I, ______________________________________, being the Client or parent(s)/guardian(s) of the Minor, do hereby declare that I am above eighteen years of age as on the date of signing this document and mentally sound and not under any fear, threat or misconception. I have read and understood the contents of this document as well as the terms and conditions of The Mind Veda available on themindveda.com and agree to abide by them.

Name of the Client: ______________________________________
Mailing Address: ________________________________________
City: ______________________ State: ______________________
Pin Code: ____________________
Email Id: _________________________ Contact No.: ____________
Emergency Contact (Relations):


Signature: _____________ Date: ______________