This page contains all necessary legal and disclosure documents for providers using LifeWave and other wellness modalities within a licensed medical facility. These forms clarify the separation between regulated medical treatments and non-invasive energy-based therapies, ensuring both legal compliance and patient transparency. Materials include provider disclosures, patient consent forms, brand partner agreements, and operational guidelines to protect your practice and define scope of service for each entity.
Required Documents for signature
These forms may vary from state to state and these are based on state of Tennessee. Contact your local Attorney. They will be updated per state as needed.
Stargate Clinic & LifeWave Disclosure Statements
1. LifeWave Disclosure for Licensed Medical Providers (MDs, DPMs, etc.)
This form explains how LifeWave® phototherapy-patch sessions offered by physicians associated with Stargate Clinic are separate and distinct from licensed medical services governed by the Tennessee Board of Medical Examiners.
- Healthcare Personel provide LifeWave services as independent Brand Partners.
- No insurance billing, prescriptions, or diagnosis occurs during patching sessions.
- Separate professional liability from medical practice.
- Client acknowledgment retained for 3 years.
2. LifeWave Disclosure for Non-Licensed Brand Partners
This form explains how LifeWave® patch sessions offered by non-licensed Brand Partners at Stargate Clinic are voluntary wellness services.
- Non-medical personnel act only as LifeWave Brand Partners.
- No diagnosis, prescription, or medical intervention is involved.
- Sessions are voluntary, non-insurance based, and separate from licensed healthcare.
3. Client Intake and Consent Form for LifeWave Services
All clients receiving LifeWave patching at Stargate Clinic must complete:
- Personal information (name, address, phone, email)
- Medical screening (major health issues, medications)
- Special disclosures (must confirm not on immunosuppressive therapy, not actively undergoing cancer care, not pregnant)
- Acknowledgment that LifeWave patching is a wellness service, not medical treatment.
- Agreement to inform primary physician of any worsening symptoms.
- Consent to participate voluntarily.
4. Brand Partner Assignment and Room Disclosure
Internal use form linking:
- Client session to assigned LifeWave Brand Partner (ID number recorded).
- Office room location at Stargate Clinic.
- Confirmation of session conducted under Stargate Clinic policies.
5. Stargate Clinic Certification of Providers
Stargate Clinic certifies independent medical practices and providers who integrate LifeWave patches as part of patient care strategies.
- Providers complete certification training.
- Agreement to uphold Stargate Clinic’s regenerative healing standards.
- Use of Stargate Clinic Certified logo and public listing.
6. Stargate Clinic Client Video Consent & Testimonial Release Form
A client video consent form is a legal document that outlines the permissions granted by a for the use of their video recordings. It typically includes details such as the purpose of the video, how it will be used and any rights the client retains regarding the footage. The form also specifies whether the video can be shared publicly or used for promotional purposes. crucial to have clients review and sign this document to ensure and legal compliance, as requirements may vary from state to state.