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Peace Valley Healing Center

 

Integrated Energy Therapy Informed Consent

 

I, ______________________________________ , (client) understand that Integrated Energy Therapy provided by Karen A. Fairman is intended to help me balance and release energy blocks in my human energy field to promote my mind, body and spirits ability to support the healing of my physical, emotional, mental, and spiritual disorders and diseases. I understand that I may experience tingling, hot or cold sensations, lightheadedness, or emotional release during a session. I will inform Karen A. Fairman of any uncomfortable sensations or physical/emotional distress during or after treatment. I understand that the session involves the use of touch on my fully clothed person in a professional manner that is consistent with the Integrated Energy Therapy Technique.

I also understand that Integrated Energy Therapy is not a substitute for medical or psychiatric treatment or medications, and that it is recommended that I consult with my primary physician or psychologist/counselor for any condition I may have. I am aware that an Integrated Energy Therapist does not diagnose disease or disorders and does not prescribe medications.

I have informed Karen A. Fairman of all my known physical and emotional conditions and medications, and will keep her notified of any updates or changes.

I have received a copy of The Peace Valley Healing Centers treatment and fee policy.

 

 

 

Client Signature_________________________________Date:__________________________

 

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Last modified: January 30, 2012