Client Consent Form

A Note from Valerie . . . .

I live in a rural area, and I understand how difficult it can be to find experienced shamanic practitioners in small towns.  In an effort to make shamanic healing available to those who need it, I do perform shamanic healing ceremonies by distance.  When possible, I recommend that you receive your session in person, from an ethical  practitioner who is experienced in shamanic healing work.  

There are several resources available to find a local practitioner in your area.   Those practitioners who have been trained by Sandra Ingerman are found at:
http://shamanicteachers.com/practitioners.html

A listing of practitioners by state can be found at:
www.shamanlinks.net

If you wish to schedule a distance session with me, please read the following paragraphs in their entirety. You are welcome to contact me if you have any questions.

CLIENT CONSENT:

By filling out this consent form, you are stating the following:

1.   I am over the age of nineteen, I am of sound mind and body and have capacity to give informed consent.   No shamanic ceremony shall be done for anyone under the age of 19 without the approval of a parent or legal guardian, and any and all sessions will take place only with a parent or legal guardian present.

2.   I am not currently taking psycho-therapeutic medication, nor am I currently under the care of a licensed psychotherapist or professional.

3.   I understand that Valerie Nunnelly (Practitioner) is not a medical doctor, nor does she represent or claim to be a licensed health care provider of any sort. No information received during my session shall be construed as an attempt to diagnosis, treat or cure any physical, mental or emotional health care problem, disorder or disease.  

4. Shamanic healing is not intended or offered as a replacement or substitute for health care treatment with a licensed and qualified health care provider, but rather as an optional, complimentary service.
 
5. I understand that all information given to the Practitioner is confidential. However, if I disclose information that would lead Valerie to believe that I intend to harm myself or others, or I have the potential to harm, or have harmed a child, Valerie Nunnelly is ethically and legally bound to disclose this information with the proper authorities.
 
6. I understand that shamanic healing addresses the spiritual causes of illness, and that the shamanic ceremony is spiritual in nature. Valerie has advised me of her belief that all healing comes from the Higher Power (God, Source, Creator, etc.) and that all healing starts within. Therefore I acknowledge that I am responsible for my own healing.
 
7. Valerie Nunnelly makes no guarantee as to any specific outcome, either written, verbal or implied.
 
I have read and I understand all of the statements above, and I agree to these terms. I certify that I will seek, the care of a licensed health care provider, if I believe that I have, or am aware that I may have a serious mental, physical or emotional problem or illness. I further agree that I will not terminate any conventional and/or alternative treatment with a licensed and qualified health care provider as a result of this work.
 
I do not hold Valerie Nunnelly legally or clinically responsible for any aspect of my physical, mental or emotional health.
 
I give Valerie Nunnelly permission to perform shamanic work by distance healing session, at an appointed time, with the specific intent to receive what is most needed in my life at this time. I agree to refrain from taking any recreational drugs or alcohol (including table wine) for a period of at least 48 hours prior to the appointed session time.
 
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