Please note: After you sign these forms and complete the booking we will send you a copy for your records.
The purpose of this consent form is to explain to you what I can offer and what you can expect.
During our sessions, we may discuss the major stresses in your life, your belief system, health history, your childhood, and other issues that have an influence on your physical, emotional, mental and spiritual well-being.
I may recommend some dietary or lifestyle changes, which you may implement if you choose.
I am not a physician or psychotherapist and do not diagnose a disease or prescribe drugs. I am a GaiaBreil Minister and have created this work and used it with clients for over 40 years.
At all times your healing is your responsibility. I am available to assist you in this process, be your committed listener and your mirror. I do not advise you to discontinue any medical treatment you may be receiving. My work is intended to be in harmony with any other healing work that you undertake, including traditional medicine. Please feel free to discuss our work with your doctors or other advisors. I may discuss, in confidence, our work together with a professional supervisor or professional peer.
Please remember: I would appreciate as much notice as possible if you have to reschedule an appointment but require a 48-hour notice minimum. You can find information about canceling or rescheduling on the ASOS website. Missed appointments without a 48-hour minimum notice regardless of the reason will be charged the full fee. Please plan ahead for incremental weather, illness or other personal situations that may arise.
The fee for each one-hour Nondual Kabbalistic Healing/Nondual Shamanic session is $235. The Cup of Kindness healings is $120. Payment can be made on-line through the booking process.
Limitations of Confidentiality
As a client receiving complementary and alternative health care services, you are entitled to have any and all information disclosed in the course of a client relationship held confidential unless you agree to release that information in writing. However, there are exceptions to confidentiality that you need to be aware of. The State of New Jersey requires me by law or my own code of ethics requires that I report the following information if it is disclosed in the course of a client relationship. If you provide me with any information regarding the following I am required to report it to the appropriate agencies.
I am required to report any information concerning the physical or emotional abuse of children.
If a child needs necessary medical care in addition to complementary or alternative services and the parent or guardian is not providing the necessary medical service, I am required by law to report this to the appropriate agencies.
I cannot keep confidential any information about your intention to harm yourself. I am required by my code of ethics to report this to the appropriate agencies.
I cannot keep confidential any information about your intention to harm another person. I am required by my code of ethics to report this to the appropriate agencies.
I am required to report any information concerning ethical violations involving another licensed or unlicensed health care provider or institution.
I may share confidential information regarding your sessions with a Professional Supervisor or a Professional Peer.