INFORMED CONSENT

My Background, Description of Services and Limitations:

My qualifications and biography are on a separate document in your client folder.

The state of Illinois  where I live requires no licenses for the work I do. 

It is simple for me to state what I do not do.  I do not diagnose or treat illness, injuries, medical conditions, mental health issues, disease or act as your physician or therapist.

First and foremost I see myself as an educator and consultant. The services I offer focus on your body’s energies. Through kinesiology I assess disturbances in the body’s energies and energy fields and facilitate corrections designed to bring disturbed energies back to a balanced and harmonious state. I help people learn how to make themselves healthier and happier. I primarily use Emotional Freedom Technique, and/or Eden Energy Medicine along with techniques of Sacred Contracts.   I educate clients such that clients can strengthen their body’s own innate healing capacity. I often will use various forms of light and deeper touch, along with movement of my hands within your energy fields, to balance and harmonize your energies. I will also suggest specific postures and movements that you can do to help balance your energies yourself. While these methods are generally gentle and considered non-invasive, it is possible that physical and emotional aftereffects may occur when your energies have been stimulated and adjusted.  I generally end sessions with instructions for energy exercises you can do at home on a daily basis.  These exercises will focus on energy imbalances identified during the session. Any discussion of health conditions is incidental to healing of energetic imbalances and should not be misinterpreted as a form of diagnosis or treatment. The work I do does not substitute for diagnosis or treatment from a qualified health practitioner.

Confidentiality, Sessions and Fees

Your experiences during our sessions are confidential, subject to the usual exceptions that you may instruct me to release information to other health care practitioners or that I may release information if subpoenaed or otherwise legally obligated or reasonably allowed to do so (including circumstances where there is clear and imminent danger to yourself or another person).  If I am working with other members of your family, we will discuss in advance the kinds of information that I may and may not reveal.

My fee is $100 per hour.  Sessions are usually ninety minutes or longer.  The fee is payable at the time of the session unless other arrangements have been made in advance.

Acknowledgement, Consent and Release of Liability

I have read and understand the above disclosure regarding the services offered by Susan Shaffer.  I understand that she is not trained to diagnose illness or handle medical emergencies.  I further understand that it is my responsibility to maintain relationships with conventional health care providers as appropriate for myself or my dependents.  I agree that I am ultimately responsible for my health care.  I knowingly, voluntarily and intelligently consent to use the services offered by Susan Shaffer  All of my questions about these services have been answered to my satisfaction.

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