Client Agreement Form

www.DanielleMansfield.com
Heal Our Souls LLC
Bodywork Specialist, Reiki Master, Shamanic Practitioner

Client Agreement and Disclosure Statement

Thank you so much for choosing me as your Healing Practitioner and Massage Therapist. I am excited about this opportunity that you are giving me to help you make major shifts in your energy, which will allow you to move forward much more smoothly and seamlessly on your exciting path to success and fulfillment.

My promise to you is that you will always be safe in my presence. You will have my full and undivided attention. In order to facilitate your flow towards healing and growth, I will always share with you any intuitive feelings that I am having about what I sense might be blocking you along your path to self-discovery, healing, and actualization of your potential.

I will be transparent with you about my own experiences and will share anything with you that I believe will accelerate your advancement to your goals – personal and professional. Be assured that I will always answer your questions directly and honestly.

Please read the Client Agreement and Disclosure Statement below – a legal document that I am required to provide for my clients as clarification of the services that I do and do not provide. All you need to do is review the standard document and sign it at the bottom.

Client Agreement & Disclosure & Policies

Massage Therapy:

I understand that the massage therapy is intended to enhance relaxation, reduce pain caused by muscle tension, increase range of motion, improve circulation and offer a positive experience of touch. Any other intended purposes for massage therapy are specified below:
The general benefits of massage, possible massage contraindications and the treatment procedure have been explained to me. I understand that massage therapy is not a substitute for medical treatment or medications, and that it is recommended that I concurrently work with my Primary Caregiver for any condition I may have.
I am aware that the massage therapist does not diagnose illness or disease, does not prescribe medications, and that spinal manipulations are not part of massage therapy.
I have informed the massage therapist of all my known physical conditions, medical conditions and medications, and I will keep the massage therapist updated on any changes.
I understand that there shall be no liability on the practitioner’s part due to my forgetting to relay any pertinent information. If I experience any pain or discomfort during the session, I will immediately communicate that to the therapist, so the treatment can be adjusted.
I understand and agree to abide by the therapists polices and will not hold Heal Our Souls LLC or Danielle Mansfield responsible for any personal injury or loss of property.

Shamanic Healing:

An Energy Healer or Shamanic Healing practitioner, or shaman is not a licensed physician. She is not qualified to diagnose, treat or prescribe for physical or mental conditions. The use of Shamanic Healing, energy healing, shamanic clearing, extractions, soul retrieval and other shamanic practices are not licensed by the State of Maryland and are considered alternative and complementary forms of health care that are unproven.

Shamanic Healing services draw on ancient healing methods that are believed to resolve toxic memories and address energetic and spiritual aspects of life conditions. Danielle Mansfield has advanced certification from both The Foundation of Shamanic Studies and The Shamanic Healing Institute as well as extensive training worldwide working with indigenous shamans. She is also a Reiki Master and has around 12 years’ experience as an advanced bodywork specialist and completed this training through various worldwide recognized institutes in the United Kingdom.

Shamanic healing addresses the energetic and spiritual aspects of illness and life conditions. There is no way to predict the results that will manifest physically and emotionally or know what you will experience. Some feel relaxation, wellbeing, and peace. Others experience moving energy, emotional release, release of memories from the past, or visions of images and colors. Some develop insight into an area of life. Others may feel nurtured or have what they describe as a spiritual experience of oneness with life. Some may experience very little.
This disclosure regarding Shamanic Energy Healing is intended to fulfill requirements of Maryland law affecting non-licensed helping professionals offering alternative complementary health care.

Policies:

Confidentiality: All services are provided in a safe, non-judgmental, confidential and supportive environment to assist clients to work towards transformation, personal growth and wellbeing. Information is not released to third parties without prior client permission.

Sessions: Sessions are available in 60 minutes, 90 minutes and 120 minutes in length unless prior arrangements have been made.

Payments: Payment for Massage therapy services are due at time of your session. The fee is $175.00 per Sixty (60) minute session.
Payment for Healing services must be discussed with Danielle Mansfield prior to your healing session.

Appointment Scheduling and Cancellation Policies:
Appointments are arranged at pre-scheduled times and, unless otherwise arranged. Since the appointment reserves a time specifically for you, a minimum of 24 hours notice is required for rescheduling or cancelling an appointment. Unless we reach a different agreement, the full fee will be charged for sessions missed without such notification.

Preparing for your appointment:
Please drink plenty of water before your appointment. Being dehydrated directly affects the flow of energy in your body and may slow down the efficiency of techniques.

Come with an open mind! It’s the only rule I have ☺

Acknowledgment of the Above

I encourage you to offer me feedback – both during and after the sessions – about how you are feeling and what you are experiencing. Please also inform me if you are experiencing any physical discomfort and/or emotional distress. If you ever have questions or concerns about the nature of the Energy Healing Methods that I am using, please do not hesitate to ask me for clarification.

I have read and understand this Disclosure and the Policies. I am aware of potential benefits and risks of treatment, my right to ask questions and to refuse any particular treatment. I give my general informed consent for treatment. Except in the case of gross negligence or malpractice, I and my representative(s) agree to fully release and hold harmless, Danielle Mansfield, from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my treatment.

You hereby 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 and that if any portion hereof is held invalid, it is agreed that the balance of this Agreement shall continue in full force and effect.

I have read and understand the above mentioned statements *
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