Professional Wellness Alliance Form (PWA)

By completing this Private Wellness Alliance (PWA) form, you're becoming part of a private member community where both clients and licensed providers commit to shared values and high standards. This alliance protects you by ensuring that our providers operate with integrity, skill, and care—and it protects us by supporting good order and trust within the community.

There is no charge for joining this alliance—it's simply part of how we keep our services personal, safe, and intentional.

📆 Important: This form must be completed before your appointment so we can be fully prepared to serve you well.

Do you agree with the following Member Agreement for joining the community? Please read the below and select "Yes" or "No" at the bottom.

Who We Are: The Professional Wellness Alliance is on a mission to assure that holistic providers have a defendable basis for offering their services and to bring individuals and families together with PWA licensed providers to learn ways to have the best in health.

How it Works: Licensed providers, Individuals and families join in a private member community to share the services defined below. The PWA is structured as a private community that requires licensing for providers to assure provider ethics, competency, and quality services along with good community order.

Services Provided: PWA licensed providers are authorized to assist members through health education, instruction and products.

Services Not Provided: PWA licensed providers do not offer any state licensed health services, DO NOT take responsibility for the health of any person or for the diagnosis, treatment or resolution of any symptom or condition.

You must agree to be accountable to the membership rules below.

1. Agree that all records of services you receive are available to you upon request as “private member educational records” and not medical records;

2. Agree that the Professional Wellness Alliance does its best to assure the integrity and competence of Provider Members (Licensees) and while Licensees represent the PWA mission, that they are independent educators that do not work for the PWA. Therefore, you agree to hold the PWA and affiliates harmless in all matters related to your association with PWA, affiliates or Provider Members;

3. Agree to make your best effort to resolve any and all complaints you may have with another member with them personally and in the event you are unable to resolve satisfactorily, agree to settle any dispute or complaint through binding arbitration through a mutually agreed arbitrator;

4. Agree that any and all content on the PWA website, newsletters, writings, affiliate links or otherwise are for educational purposes only and are not intended as medical advice.

Term and Cancellation: Membership in the PWA shall begin when you agree to this Membership Agreement and shall terminate with written notice from you to the PWA or from the PWA to you. The PWA reserves the right to deny or terminate membership of any member without cause. Termination shall not waive or relieve you of any obligations or agreements made while you were an enrolled member.

By agreeing to membership though this on-line electronic system you accept membership and agree that this agreement is a “contract” binding you to follow the herein terms.