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Consent Form 

Resilience Reiki, LLC/April Jay Mentorship + Healing
Services Agreement and Consent Form 

PLEASE READ THE FOLLOWING CLIENT INFORMATION

Your Healing Guide


April Unterberger, referred to in this contract as Resilience Reiki, LLC, is an energy healing guide, Shamanic Practitioner, and Reiki Master with a Master’s degree in Social Work.

 

April is an energy healing guide operating under Oregon’s “educational licensing exemption” under ORS 675.825(4)(a), which allows alternative practitioners and counselors to practice legally in Oregon without a license.

What is Energy Healing + Shamanic Coaching?


Energy Healing is a technique for stress reduction and relaxation that also promotes healing. It is administered by utilizing healing touch or distance healing methods and is based on the idea that an unseen "life force energy" flows through us and is what causes us to be alive.

 

If one's life force energy is low or blocked, then one is more likely to experience illness or stress. If it is high, one is more capable of feeling relaxed, happy and healthy.

 

The practitioner combines energy healing with shamanic coaching, a form of motivational, solution focused guidance. Coaching is not therapy and is not to be used in substitution for therapy. 

Nature of the Treatment


Energy healing utilizes the theory that light touch of the practitioner’s hands combined with intuitive abilities promotes energy balance, improving overall healing of the client.

 

The client can expect to be fully clothed in a lying or sitting position and will experience light touch, if touch is consented to by the client. Through light touch, energy healing can help achieve emotional balance and inner peace.

 

Energy healing may help develop a stronger sense of self and improved mood balance. Results of energy healing may vary for individuals. Therefore, a specific outcome cannot be guaranteed by the Practitioner.

What Energy Healing/Shamanic Coaching is Not


Energy Healing is not psychology, psychiatry or medicine and the practitioner is not a licensed physician, psychologist, or psychiatrist. Energy Healing is intended to be a complement to traditional medicine provided by doctors, nurses, and other licensed medical professionals. If you believe you are ill, please see a licensed medical professional prior to beginning your treatment.


Client certifies that they do not suffer from any physical or mental disability that may affect their participation in the services with the practitioner and if they have a mental or physical illness, they have consulted with their health care provider and have been advised they may participate in the services by the practitioner.

 

Client agrees if there is any change in representation, the practitioner will be promptly advised.

 

Client is responsible for creating and implementing their own physical, mental, and emotional well-being, decisions and results. Therefore, the client agrees that the practitioner is not and will not be liable for any actions or inactions or of any direct or indirect results of the services provided by the practitioner.


The practitioner makes no guarantees or warranties, expressed or implied. In no event will the practitioner be liable to the client for consequential or special damages.

 

I, the client, agree that in the event of any claim or grievance by me against the practitioner, my sole remedy will be the return of the fees paid. The practitioner is not responsible for any direct, indirect or incidental or consequential damages beyond the total amount of fees paid by the client.

ACKNOWLEDGEMENT & CONSENT TO RECEIVE SERVICES 

  1. I have read Client Information and understand the above guidelines and disclosure about the treatments and techniques offered by Resilience Reiki, LLC as well as her training and education.

  2. I understand that Resilience Reiki, LLC is not a licensed physician and that the alternative services I will be receiving are not licensed nor required to be licensed in the State of Oregon.

  3. I have discussed any concerns I have with the practitioner about the nature of the treatment I will be receiving.

  4. I will immediately inform the practitioner if I experience any discomfort during the session(s).

  5. I acknowledge that long-term imbalances in the body may require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.

  6. I understand that it is my responsibility to maintain a relationship for myself and/or my child with a medical doctor.

  7. I understand that energy healing is not a substitute for medical treatment or medications. I am aware that Resilience Reiki, LLC does not diagnose illness or disease nor does she prescribe medications or recommend supplements. I understand that any suggestions that are provided to me should not be taken as a diagnosis or recommendation against the advice of a licensed physician or mental health professional.

  8. I have consented to use the services offered by Resilience Reiki, LLC and I agree to be personally responsible for her fees in connection with the services provided.

  9. I understand energy healing may consist of light on the body touch. By signing below, I agree to physical touch by the practitioner.

  10. I understand if I cancel or reschedule my appointment with less than 24 hours notice, I will be charged the full appointment/class/workshop fee.

  11. I understand Resilience Reiki, LLC does not offer refunds.

Privacy Notice: No information about any client will be discussed or shared with any third party without written consent of the client or parent/guardian if the client is under 18.  

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