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Client Agreement for Services, Disclosures & Consent for Remote Energy Medicine Sessions

Practitioner Name:  Laurie Cole
 
Practice Location: Love Learn Laugh with Laurie
 
Contact: laurie@lovelearnlaughwithlaurie.com
Definition of Energy Medicine

Energy Medicine is holistic integrative therapy intended to clear, balance and energize the human energy system in order to facilitate physical, emotional, mental, and spiritual self-healing.  

 

The trained practitioner uses various energy medicine techniques with heart-centered intention. Energy medicine is intended to complement and not replace any prescribed medical care. Practitioners do not diagnose conditions or prescribe treatment.

 

DISCLAIMER:  Working with Laurie Cole is not meant to prevent, diagnose, treat, or cure any condition you may be experiencing. It is not meant to replace the advice or care of your team of healthcare professionals.

PERSONAL RESPONSIBILITY: You take 100% responsibility for your health even during and after receiving healing. Please come ready to participate.

SEVERE OR LIFE-THREATENING ALLERGIES:  Client understands and agrees that if Client has severe or life-threatening allergies, it is Client’s responsibility to disclose this information to Company prior to beginning any healing work.
Client also understands and agrees that it is Client's’ responsibility to take the necessary precautions to avoid severe and life-threatening allergens.
IF YOU HAVE SEVERE OR LIFE-THREATENING ALLERGIES, CONTINUE TO TAKE THE NECESSARY PRECAUTIONS EVEN AFTER RECEIVING THE HEALING UNLESS OTHERWISE INSTRUCTED BY YOUR HEALTHCARE PROFESSIONALS.
IF YOU EXPERIENCE SYMPTOMS OF A SERIOUS ALLERGIC REACTION, CALL 911 OR GO DIRECTLY TO THE NEAREST EMERGENCY ROOM.

**Additional Note on Severe Allergies: Client understands and agrees that severe allergies may require more sessions than other allergies.

 

NO GUARANTEES: Company makes no guarantees about the results Client will receive through working with Laurie Cole. Client agrees that any statements made by Company regarding potential outcomes are opinions and are not binding on Company. Results are dependent on many factors including but not limited to the severity of the allergies, the level of compliance with instructions, in addition to other factors that you and/or Company may not be able to anticipate.

Session Information

Remote energy medicine services involve the use of secure interactive videoconferencing devices and equipment that enable the practitioner to deliver services to the client virtually when they are located at different sites.

Sessions are (x) minutes long.

 

The fee per session is $ (x).

 

Laurie Cole is not a provider for any insurance carrier.

 

  1. I understand that the same standard of care applies to a remote session as applies to an in-person visit.

  2. I understand that the laws that protect the privacy and confidentiality of personal information apply to remote sessions.

  3. I understand that I will not be physically in the same room as the practitioner. I will be notified of this, and my consent obtained for anyone other than the practitioner to be present or work with me.

  4. Risks to Confidentiality: I understand that as remote sessions take place outside of the practitioner’s office, there is potential for other people to overhear conversations if I am not in a private place during the session. The practitioner will take reasonable steps to ensure privacy. It is my responsibility to find a private place for the session where I will not be interrupted. I also understand that it is my responsibility to protect the privacy of our session on the device being used.

  5. Technology Issues: I understand that there are potential risks to using technology, including service interruptions, interception, and technical difficulties. For example, technology may stop working during a session, other people might be able to get access to our private conversations, or stored data could be accessed by unauthorized people or companies. If it is determined that the video conferencing equipment or connection is not adequate, I understand that either the practitioner or I may discontinue the remote session and make other arrangements to complete the session.

Appointment Cancellation Policy

I agree to give a 24-hour notice if it is necessary for me to cancel an appointment. Ten minutes or more is considered a no show.

Refunds

Client is responsible for full payment of fees for the entire Program, regardless of whether client completes the Program. To further clarify, no refunds will be issued.

Confidentiality

All client information and records are treated in a confidential manner and no information will be released to anyone without my prior written consent, except in situations governed by law.

This Agreement is considered a mutual non-disclosure agreement. Both Parties agree not to disclose, reveal or make use of any information learned by either party during discussions, Or otherwise, throughout the Term of this Program (“Confidential Information”). Confidential Information includes, but is not limited to, information disclosed in connection with this Agreement, and shall not include information rightfully obtained from a third party. Both Parties shall keep all Confidential Information strictly confidential by using a reasonable degree of care, but not less than the degree of care used by it in safeguarding its own confidential information. The obligation of the Parties hereunder to hold the information confidential does not apply to information that is subsequently acquired by either Party from a third party who has a bona fide right to make such information available without restriction.

 

Both Parties agree that any and all Confidential Information learned as of the Effective Date shall survive the termination, revocation, or expiration of this Agreement.

Disclosures

  • Energy Medicine practitioners do not diagnose conditions or prescribe treatments.

  • No specific claims will be made by the practitioner regarding results from the Energy Medicine sessions.

Practitioner Liability Insurance

Tokio Marine Specialty Insurance Co

Hold Harmless Clause

Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless, Laurie Cole and Love, Learn, Laugh with Laurie LLC, from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

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