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R Leah Moon: Energy Medicine
BCND, ThM, BS
Multimodality Energy Medicine Practitioner
www.rleahmoon.com 806.341.7106 firstname.lastname@example.org
CLIENT AGREEMENT AND DISCLOSURE STATEMENT
Welcome! Thank you for your interest in working with me as a client either in person or via distance by telephone or internet (Skype, email), whichever is applicable. I am providing you with the following information so you can make an informed choice about your decision to engage my services. Please read this information carefully and let me know if there is any part you do not understand.
I work with clients in a number of areas including, a wide variety of life issues, overall health and wellness, nutrition, spiritual transformation, and recovery from illness or injuries. My focus with a client is to work with the whole person, using a number of energy healing techniques designed to assist the client in achieving balance in mind, body, and spirit. I use a variety of energy oriented methods, including, The Body Code System, The Emotion Code, Emotional Freedom Techniques, Quantum Touch, Be Set Free Fast, and also Nous Essence Alignment Technique (NEAT), which I developed to support the various energy healing methods I offer to my clients (collectively the “Energy Methods”). In addition, as a Consulting Hypnotist, I incorporate hypnosis in energy sessions as I have found hypnosis helpful in resolving issues more quickly for clients and it can enhance the results of an energy session. Also I offer Angel Card Readings, Angel Healing Sessions, Medium Sessions, and pastoral counseling as more fully described on my website. You can choose a specific energy session or package of energy oriented services as published on my website that incorporate one or more of the Energy Methods. You also have the option of using individually or collectively any of the Energy Methods and other services I offer as part of our work together.
ENERGY METHODS/THEORETICAL APPROACH
Energy Methods is a collective term used to refer to a variety of energy healing techniques based on the use and modification of energy fields. The Energy Methods are designed to assess where the body’s energies are blocked or not in harmony and then correct and balance the flow of these energies thereby aligning the body’s energies to boost health and restore vitality. The prevailing premise of the Energy Methods is that the flow and balance of the body’s electromagnetic and more subtle energies are important for physical, spiritual, and emotional health, and for fostering well-being. With any of the approaches I use, I will encourage you to ask questions and to provide feedback to me so I can monitor how you are feeling and what you are experiencing.
Emotional Freedom Techniques (EFT)
EFT is an innovative energy oriented coaching and self-help technique based on the newly emerging field of energy psychology. EFT uses the ancient Chinese meridian system with a gentle tapping procedure which stimulates designated meridian end points on the face and body while saying specific phrases and focusing on issues of emotional intensity in order to release the intensity and reframe the issues. In an EFT session, the client does the tapping on the client’s own body and the practitioner helps guide the session by instructing the client where to tap while saying specific phrases based on the issues that are being worked on. Occasionally and depending on the circumstances, it may be best for me to tap on the client’s body but I will only do so after receiving permission from the client.
The Body Code System and The Emotion Code
These methods were developed by chiropractor Bradley Nelson and are designed to allow the practitioner and client to communicate directly with the client’s subconscious mind and to use Body Code Mind Maps to correct energy imbalances to release trapped emotions and to help create optimal health.
The Quantum Touch techniques are designed to focus, direct, and amplify life-force energy (or Chi, Bioenergy, Prana) by combining various breathing and body awareness exercises to help facilitate the body’s own healing process. Quantum Touch is based on the principles of resonance and entrainment. In physics, entrainment theory is the process where two vibrating objects, vibrating at different speeds, start to vibrate at the same speed when energy is transferred between the two objects. When using the Quantum Touch techniques, it is believed a higher frequency of life-force energy can be created and placed around the client. Then the client’s body can entrain to the higher frequency thus amplifying the client’s body’s ability to heal.
Be Set Free Fast (BSFF)
Be Set Free Fast was developed by Larry Nims, PhD and is designed to eliminate the emotional roots and self-limiting belief systems that are embedded in the subconscious mind that establish and trigger debilitating and dysfunctional reactions. Unlike EFT, BSFF does not use meridian tapping but instead uses thought energy and intention.
Nous-Based Healing (NBH) – Nous Essences Alignment Technique (NEAT)
NBH is best described as a metaphysical paradigm, an expanded awareness umbrella that encompasses but is not limited to time, dimensions, energy healing, spirituality, intuition, and the quantum fields. NEAT functions to provide the service and tools of NBH and was developed to support the various energy healing methods I offer to my clients. NEAT is designed to facilitate finding distorted energy patterns where I access the quantum field to connect with the source of life energy, a divine substance which holds the uncreated potentiality to manifest the seen and the unseen.
Muscle Response Testing
In some of the Energy Methods I use elements of kinesiology or “muscle-testing” that involve a light pressure/counter pressure technique on your outstretched arm. This technique is a way of assessing the energy flow through certain areas of your body and often helps to identify the specific techniques that will be most beneficial for your needs. Muscle testing can be used directly on the client with permission, via a surrogate or I can muscle test on myself for the client.
HYPNOSIS USED IN ENERGY SESSIONS
As part of an energy session, I often will integrate hypnosis to help facilitate a quicker resolution of the issues presented by the client and with the intention to enhance the results of an energy session. Hypnosis is a naturally altered state that we move in and out of all of the time like when we are falling asleep or daydreaming. The hypnotic state is a unique self-generated state of suggestibility that only you can induce through your own intentions. Hypnosis provides us an opportunity to choose to access the higher aspects of ourselves from an open and more suggestible space. Transpersonal hypnosis creates fertile soil that allows for a space of quietness for seeing and growing. It can be utilized as a learning tool as well as an aid to those desiring spiritual unfoldment. You understand I offer my services solely as a consulting hypnotist for learning purposes and not as a form of health care, medicine, or psychotherapy.
NATURE OF THE RELATIONSHIP
While I have extensive experience as a healing arts practitioner, I’m not a physician, psychologist, psychotherapist, or other licensed health care provider nor are my services licensed by the State of Texas. When using the Energy Methods I’m not “diagnosing” or “treating” the physical body which is the domain of the medical field and other allied health care professionals but instead, as an energy healing practitioner, I’m connecting to the energy or subtle “bodies” of the client which then can manifest in the physical body. You understand there is a distinction between “healing” using the Energy Methods and the practice of medicine or any other licensed health care practice. Although the Energy Methods appear to have promising mental, spiritual, and physical benefits, they have yet to be fully researched by the Western academic, medical, and psychological communities and therefore, are consider experimental. The Energy Methods are self-regulated and they are considered “alternative or complementary” to the healing arts that are licensed in the State of Texas. If you ever have questions or concerns about the nature of the theories and methods I use, please feel free to ask me for further resources or references.
CLIENT HISTORY WITH REGARDS TO TOUCH FOR IN-PERSON SESSIONS
Touch can be a potential problem in a healing relationship if you have had a history of any kind of trauma around touch. If you have any misgivings, doubts, or any negative reactions to any physical contact, it is very important that you let me know as soon as possible so that we can discuss your concerns. You understand you have a choice about these techniques that involve touch. I will always ask your permission before touching you and if at any point you feel uncomfortable you may request we stop. If you are uncomfortable talking to me, I encourage you to talk through such concerns with another professional. If you wish, I can make a referral for you.
OUTCOME EXPECTATIONS/RISKS & BENEFITS
Please note that it is impossible to guarantee any specific results and we don’t know how you will personally respond to the services I offer, including the Energy Methods. However, we will work together to achieve the best possible results for you. Participation in a wellness program can result in a number of benefits to you, including improvement in overall health and well-being, and resolution of the specific concerns that led you to seek help.
Most clients report pleasant experiences with using the Energy Methods and they are generally considered gentle and non-invasive. However, it is possible in our sessions together or on your own between sessions to experience some physical discomfort or emotional distress which could be perceived as negative side effects. Also, emotions may continue to rise after a session or additional unresolved memories may surface which may be perceived as negative side effects. Occasionally, some people have experienced dizziness, nausea, or anxiety as occasional side-effects from energy work. If any method or process is uncomfortable or does lead to distress or discomfort, please tell me at once. I will stop immediately and can often provide a technique to rebalance the energies whose stimulation is causing distress or discomfort. If appropriate, I can help refer you to a professional health care provider for further assistance.
In using the Energy Methods, it’s possible that previously vivid or traumatic memories may fade which is a positive outcome. However, this could adversely impact your ability to provide legal testimony that carries the same emotional impact as prior to applying the Energy Methods regarding a traumatic incident. Regardless of our work together, you agree to take full responsibility for your self-care in the emotional, physical, and spiritual dimensions of your life.
LIMITATIONS OF MY PRACTICE
Please be advised the services I offer and the use of the Energy Methods are not intended to be a substitute for the diagnosis and/or treatment of medical conditions or psychological disorders and they do not replace the services of health care professionals. You agree and understand it is your responsibility to consult with your health care provider for any specific health care problems. Further, you understand I may suggest you contact your professional health care provider if I believe it’s advisable. In addition, you understand that any information shared during our sessions is not to be considered a recommendation that you stop seeing any of your health care professionals or using prescribed medication, if any, without consulting with your health care professional, even if after working together it appears that such medication or treatment is unnecessary.
EDUCATION AND TRAINING
I have an extensive background in the healing arts. Please refer to my website for a list of the various academic degrees, certifications, and other trainings I have obtained.
SALE OF WELLNESS PRODUCTS
I may include the recommendation of wellness products as part of your wellness plan. As a service to you, I make available some wellness products on my website. You understand that I have a financial interest in selling these wellness products. You are under no obligation to purchase any wellness products from me and the quality of the wellness services you are offered will not be affected if you choose to either purchase any wellness product elsewhere or not to follow the recommendations that you use certain wellness products.
ACKNOWLEDGMENT & 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 using the services I offer. You have considered all of the above information and have obtained whatever information or professional advice you deem necessary to make an informed decision.
By signing this document you understand I am offering my services solely as an energy medicine practitioner and consulting hypnotist and our relationship is not to be construed as medical treatment, psychotherapy, psychological counseling, or any type of therapy, nor is it a substitute for these services. You understand that it is your responsibility to maintain a relationship with a health care professional. You represent your consent to the nature of our sessions is given voluntarily, without coercion, and may be withdrawn at any time in the future. Further you represent that you are competent and able to understand the nature and consequences of the proposed sessions and agree to be personally responsible for the fees related thereto. You have discussed with me the nature of the services to be provided and you understand that I’m not a licensed health care provider and that my services are not licensed by the State of Texas. Further you understand the Energy Methods are relatively new healing approaches and the extent of their effectiveness, as well as their risks and benefits are not fully known. Therefore, you agree to assume and accept full responsibility for any and all risks associated with using the Energy Methods to the fullest extent allowed by law. You acknowledge that you have received a copy of my Additional Client Information & Office Policies & Procedures which is attached hereto and incorporated herein by reference.
By signing in the space provided below, or electronically providing a signature, you knowingly, voluntarily, and intelligently assume these risks and except in the case of gross negligence or malpractice agree to release, indemnify, hold harmless and defend R. Leah Moon, her employees, representatives, independent contractors, consultants, volunteers, and others associated with R. Leah Moon from and against any and all 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.
Please indicate your acceptance and agreement by signing in the space provided below*:
Signed: __________________________________ Date: ___________
Print Name: ______________________________
I am the parent or legal guardian of the above-named minor, and I consent to and join in the foregoing Agreement on behalf of said minor.
Signed: __________________________________ Date: ____________
Print Name: _____________________________
*If you are submitting this Agreement electronically, typing your name in the space provided above will be considered your signature and constitute your acceptance and agreement of this Agreement.
R Leah Moon: Energy Medicine
BCND, ThM, BS
Multimodality Energy Medicine Practitioner
www.rleahmoon.com 806.341.7106 email@example.com
ADDITIONAL CLIENT INFORMATION &
OFFICE POLICIES AND PROCEDURES
Session length and fees vary according to which package is purchased and the Energy Method used. Individual sessions or a package of sessions can be purchased. Please refer to my website for current session lengths and fees.
HELPFUL INFORMATION & POLICIES
Please refer to my Helpful Information & Policies page on my website which is incorporated herein by reference and made part of this Client Agreement & Disclosure Statement.
With the exception of 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 health care 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 child, elderly or disabled person is being abused
4. If I am presented with a legitimate court order to present testimony in a legal proceeding
4. If a client fails to pay for services requiring action to collect fees due;
Further, please be advised that if any communication regarding our work together is conducted over the phone or via Skype and with email it is not possible to guarantee the confidentiality of the information contained in any of our telephone and/or electronic communications.
Sessions may be paid for by personal check, cash, or credit card or via PayPal. I do not bill through insurance so my work is on a fee for service basis. Payment is expected prior to the appointment, unless previous arrangements have been made. Please notify me right away if a problem arises regarding your ability to make payments.