Informed Consent Liability Waiver and Release
+ Informed Consent to Treat for Energy Healing and Intuitive Consultation
Description of services and experience:
Energy healing treatments enhance and improve the complex interconnections between the physical, mental, emotional and spiritual bodies of an individual. Modalities such as Reiki, Energy Medicine, shamanic healing, and yoga work with subtle energy systems, within and around the physical body and act as conduit systems through which our spirit connects with our mind and physical body.
Creating harmonious energy fields provide an alignment, personal empowerment and renewed and increased energy or life force. In energetic integrity we are able to create and manifest what we desire in our lives. When our physical, emotional or spiritual body are out of alignment due to emotional trauma, physical injury, unresolved memories, environmental or food toxins, addictions, poor relationships or living an ungrounded, unconscious life, we lack the necessary vitality for life and can become physically ill, depressed, stuck and have difficulty creating a holistically harmonious life. Conscious and unconscious thoughts, fears, life experience, grievances, intentions, and belief systems as well as family, friends and social influences are imprinted into our subtle energy systems as well as physical body. This impacts how one feels and expresses oneself in the world.
During personal sessions and/or classes, holistic techniques such as energy healing, chakra balancing, Reiki, and intuitive consultation are presented to the client and applied to influence the subtle energy systems in support of healing the body, mind, and spirit. During a session, various sensations may be experienced such as tingling, feelings of being touched, temperature changes, a sense of floating, being disoriented or out of body, and deep relaxation, for example. After a session, clients may sometimes experience an increased flow of energy throughout their body and soul creating an increased sense of well-being. However, there also may be thirst, hunger, fatigue, or a light headache. Energy work may bring about the release of old emotions such as grief, sadness or anger as part of the healing process and may also bring up outdated energetic patterns and behaviors to be released, including but not limited to, relationships with work, friends and family members. Clearing such imbalances in your subtle body may be reflected in your relationships with others and the world. Please be aware that you are releasing what is no longer serving you.
Clients often find it appropriate to relax right after a session and allow the integration of the energy work to continue. Drinking water and relaxing helps the body and soul to integrate the energetic adjustments. It is recommended to contemplate any intuitive insights received before taking any action based on a consultation to decide if it is best for you. If you experience any discomfort or uncertainty that you believe is a result of or related to any aspect of the energy healing experience, please communicate this experience to us. Energy Medicine as a holistic health practice is a personal choice in self-discovery and personal transformation and evolution.
Liability Waiver and Release
I am here to inspire my own personal transformation. I take personal responsibility for my well-being and with respect for myself I accept responsibility for my choices. My heirs, guardians, legal representatives, and I hereby and forever release, waive, and discharge any claims against Radiance Energy Healing, Stephanie Poulos, and/or any of their associates or affiliates. I take full responsibility and am responsible for all liability for loss or injury incurred while in association with or applying energy techniques and information learned from Radiance Energy Healing / Stephanie Poulos. I consent to light touch as part of a Reiki treatment. I have carefully read this agreement and fully understand its content. I am aware that this is a waiver and release of potential liability and a contract between the above noted parties and myself. I understand that this contract is binding and acknowledge that I am signing this of my own free will.
ENERGY HEALING MODALITIES INFORMED CONSENT TO TREAT
I hereby request and consent to the performance of energy healing modalities and treatments within the scope of the practice of Radiance Energy Healing, Stephanie Poulos, or any employees, contractors, or affiliates, on me (or on the patient named below, for I am legally responsible) by Stephanie Poulos, or another practitioner, working or associated with Radiance Energy Healing.
I understand that methods of treatment may include, but are not limited to: Reiki, intuitive consultation, chakra balancing, energy healing, past life, shamanic healing and journeys, meditation, visualizations, spiritual counseling, and yoga. I will immediately notify my energy practitioner listed below of any unanticipated or unpleasant effects associated with any of the energy modalities applied.
I have been informed that energy medicine is a generally safe method of treatment, but that shifts in energy occur and may create some physical, emotional or spiritual side effects which may include physical tingling, feeling lighter energetically, mild fatigue, nausea, muscle soreness, headache, thirst, changes in relationships, shifts of perception, etc. I do not expect the energy practitioner to be able to anticipate and explain all possible risks and complications of energy treatment, and I wish to rely on the energy practitioner to exercise judgment during the course of treatment in which the energy practitioner operates in the best and highest interest for my healing, based upon the facts then known and for my best interest and highest good. I understand that results are not guaranteed.
I understand that all clinical information and records of energy healing treatments etc. will be kept confidential and will not be released without my written consent. By voluntarily signing below, I show that I have read, or have had read to me, the above consent to treatment, have been told about the risks and benefits of energy medicine and intuitive energy healing and other energy modalities, and have had an opportunity to ask questions. I intend this consent form to cover the entire course of my energy treatments for my present condition and for any future conditions(s) for which I seek any energy healing modalities.