CLIENT AGREEMENT AND DISCLOSURE STATEMENT FOR ENERGY SESSIONS
Welcome! Thank you for your interest in working with me as a client either in person or remotely. I specialize in guiding my clients to release stress, to heal their wounds of physical and/or emotional trauma, gain greater clarity, achieve optimal health, and experience expanded awareness, inner peace, and a renewed sense of wholeness and balance in their lives. I offer private sessions focused on tailored solutions addressing each client’s specific needs for healing and personal transformation. As an intentional and conscious participant in your growth, you will ultimately take all responsibility for, and actions related to your mind-body-spirit health and well-being.
OUTCOME EXPECTATIONS, RISKS, AND BENEFITS
Energy work provides a comprehensive framework for assessing, correcting, and stabilizing the subtle energy flows of the body and the integrity of the body-field through the work we do together in the session and the recommended protocols you follow at home. However, it is impossible to guarantee any specific results. We do not know how you will personally respond to the services I offer, but we will work together to achieve the best possible results for you. While the methods I use and teach are gentle and considered safe and non-invasive, it is possible to experience some physical discomfort or emotional distress. It is your responsibility to notify me of questions or concerns you have as well as to schedule any follow-up sessions you desire.
LIMITATIONS OF MY ENERGY WORK PRACTICE
The field of energy work is, for the most part, self-regulated, and it is considered complementary or alternative to the traditional healthcare professions that are licensed in the United States and the State of Colorado. As a Complementary and Alternative Healthcare Practitioner, I am not licensed, certified, or registered by the State of Colorado as a Healthcare Professional. While I have extensive training and experience in the healing arts, I am not a physician, psychologist, psychotherapist, or other licensed healthcare provider, nor are my services licensed by the State of Colorado. I am covered by Professional and General Liability Insurance applicable to any injury caused by any act or omission in providing the complementary and alternative healthcare services I offer.
Energy work is not a substitute for the diagnosis and/or treatment of medical or mental health conditions by a licensed healthcare professional. If you have a disorder that has been previously diagnosed, treated, or managed by a licensed medical or mental health professional, my services should be used only in conjunction with your obtaining that care. In addition, any information shared during our sessions is not to be considered a recommendation that you stop seeing any of your healthcare professionals or using prescribed medication, if any, without consulting with your healthcare professional, even if after a session it appears and indicates that such medication or treatment is unnecessary. Regardless of our work together, you agree to take full responsibility for your self-care in the mental, physical, spiritual, and emotional dimensions of your life.
ACKNOWLEDGMENT AND CONSENT TO RECEIVE SERVICES
By signing this document, you agree that I have disclosed to you sufficient information to enable you to decide to undergo or forgo the services I offer and have obtained whatever information or professional advice you deem necessary to make an informed decision. You further state that your consent to the nature of our sessions is given freely, without coercion, and that you understand that it may be withdrawn at any time in the future. You represent that you are competent and able to understand the nature and consequences of the proposed sessions. You agree to be personally responsible for the fees related to your services.
For valuable consideration, the sufficiency and receipt of which is hereby acknowledged, you knowingly, voluntarily, and intelligently assume any risks and agree to fully release and hold harmless Elizabeth Ortega from and against any claims of whatsoever kind or nature, which you, or your representatives, may have for any loss, damage, or injury arising out of or in connection with your sessions.
CONFIDENTIALITY
Except for the special situations described below, I will keep our work together confidential. I cannot and will not tell anyone else what you have told me, or even that you are using my services without your prior written permission. You may direct me to share information with whomever you choose, and you can change your mind and revoke that permission at any time.
Although I am not a licensed professional healthcare provider, I choose to be in alignment with general ethical standards by adhering to the following legal exceptions to confidentiality:
1. If I believe the client is in imminent danger of hurting herself/himself
2. If I believe the client is threatening serious bodily harm to another
3. If I believe that a minor, elderly, or disabled person is being abused
4. If I am presented with a legitimate court order to present testimony in a legal proceeding
5. If a client fails to pay for services and requires action to collect fees due.
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SESSION INFORMATION
Private healing sessions are tailored to address each client’s specific needs for healing and personal transformation.
Please note that you will remain fully clothed for all types of sessions. It is recommended that you wear comfortable, loose-fitting clothes and remove belts, electronics, and large jewelry items.
PAYMENTS
Payments must be made before or at the time of the appointment. Please notify me immediately if a problem arises regarding your ability to make payments. You have the option of paying for your sessions by cash, PayPal, Venmo, or credit/debit card via the booking calendar. I work on a fee-for-service basis and am unable to bill through insurance.
CANCELLATIONS
Scheduling of appointments involves the reservation of time specifically for you. Therefore, I require 24-hour minimum advance notice for rescheduling or canceling an appointment. The full session fee may be charged for missed appointments without such notification. Emergencies will be considered on a case-by-case basis.
ENERGY WORK CONSENT AND RELEASE STATEMENT
I understand that the energy work session given may involve a natural hands-on and off method of energy balancing including, but not limited to pain management, stress reduction, and relaxation. I understand very clearly that these treatments are not intended as a substitute for medical or psychological care.
I understand that energy work practitioners do not diagnose conditions, nor do they prescribe medicines, or interfere with the treatment of a licensed medical professional. It is recommended that I seek a licensed health care professional for any physical or psychological ailment I have.
I understand that the practitioner may be placing hands on me during the energy work session.