Thank you for your interest in working with me as a client either in person, by phone, or Skype, 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.
Theoretical Approach/Services Offered In my practice I use several innovative techniques which you have the option of using individually or collectively as part of work together. I offer energy sessions, intuitive readings, sound healing, and flower essences, (collectively “Energy Medicine”) and I also incorporate restorative yoga. Energy Medicine is a collective term used to refer to a variety of methods that are based on the use and modification of energy fields that look at the energetic influence of thoughts, beliefs, and emotions on the body. The prevailing premise of Energy Medicine 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. As an intuitive practitioner of the healing arts, I use Energy Medicine techniques to balance my clients’ energy systems and to communicate spirit-to-spirit with my clients.
Although Energy Medicine uses the term medicine, it does not imply that Energy Medicine practitioners are practicing medicine. Energy Medicine techniques do not “diagnose”, “treat”, or “cure” any medical or mental-health disorders. You understand there is a distinction between “healing” using Energy Medicine techniques and the practice of medicine or any other licensed health care practice. As an Energy Medicine practitioner, I’m connecting to the energy or subtle “bodies” of the client that makes it possible to manifest a change or transformation which is then experienced directly by the client. 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.
Although Energy Medicine appears to have promising mental, spiritual, and physical benefits, it has yet to be fully researched by the Western academic, medical, and psychological communities and therefore, is considered experimental. The Energy Medicine techniques I use in my practice are considered alternative or complementary to healing arts that are licensed by the State of California. Although I have extensive experience in the healing arts, I’m not licensed in the State of California as a physician, psychologist, or other licensed health care provider nor are my services licensed by the State of California. Under Sections 2053.5 and 2053.6 of California’s Business and Professions Code, I can offer you my services, subject to the requirements and restrictions that are described fully therein.
Outcome Expectations / Risks & Benefits The Energy Medicine methods I use appear to result in positive outcomes and clients have found them to be effective and beneficial. However, it’s not possible to guarantee any specific results regarding your goals using any of the Energy Medicine techniques or products I offer, and we don’t know how you will personally respond to any of the Energy Medicine techniques. However, we will work together to achieve the best possible results for you. The clinical reports from Energy Medicine show no significant side-effects when used appropriately. However, please be advised that in our work together it’s possible to experience some emotional distress and/or physical discomfort which could be perceived as negative side effects. It is also possible to experience some emotional distress and physical discomfort related to stressful experiences you may have had earlier in your life. You agree to promptly inform me if you experience any emotional distress and/or physical discomfort during our work together. If appropriate, I can help refer you to an appropriate professional health care provider for further assistance.
Nature of the Relationship My work with you as an intuitive counselor and energy balancing practitioner is not intended to be used to diagnose, treat, cure, or prevent any disease or psychological disorder; our sessions together do not replace the advice and/or services of health care professionals. You agree to consult with your health care provider for any specific health care problems and understand that 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 a session it appears and indicates that such medication or treatment is unnecessary. You agree to take full responsibility for your self-care in the, emotional, mental, physical, and spiritual dimensions of your life. You agree to contact me directly if you have any concerns about your experiences with your energy sessions and/or our relationship as practitioner and client.
For further information about my practice, including my office policies, please refer to the attached Client Information & Office Policies which is incorporated herein by reference and made part of this Client Agreement & Disclosure Statement.
Education and Training In 2010 I earned a Masters of Intuition Medicine (MIM) vocational certificate from the Academy of Intuition Medicine® which is approved by the State of California as an accredited postsecondary vocational training institution.
Termination At any time during our work together if I determine, in my sole discretion, that I cannot be of benefit to you or not effective in helping you reach your goals, I have the right to terminate this Agreement and our practitioner-client relationship. In such a case, upon your request, I will give you referrals that you can contact. You have the right to terminate this Agreement and our practitioner–client relationship at any time.
Confidentiality 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 5. If a client fails to pay for services requiring action to collect fees due 6. If I believe any criminal activity is taking place.
Further, please be advised that if our sessions are being 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.
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 whether or not to engage my services. You understand that you are freely choosing to take advantage of my intuitive counseling and energy balancing services and would otherwise have the option of using another practitioner of your choosing. You understand that 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 understand the extent of Energy Medicine’s effectiveness, as well as its risks and benefits are not fully known and you agree to assume and accept full responsibility for any and all risks associated with using Energy Medicine. Further, you agree and understand that this Agreement is intended to be a complete unconditional release of liability and assumption of risk to the greatest extent permitted by law. You represent that you’re competent and able to understand the nature and consequences of our proposed sessions and agree to be personally responsible for the fees related thereto.
You have read and understand the above disclosure about the services offered by me and my training and education. You have discussed with me the nature of the services to be provided and you understand my services as an intuitive counselor and energy balancing practitioner are not licensed by the State of California. By signing in the space provided below, you knowingly, voluntarily, and intelligently assume these risks and agree to forever release, indemnify, hold harmless and defend Mary Spicer and her agents, consultants, and employees 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.
In order to use my services, California state law requires that you acknowledge receipt of the information provided in this Client Informed Consent and Disclosure Statement. I will keep an original in my records for at least three (3) years.