Consent form for Energy Healing/Spiritual Healing and Coaching For Greg Bottoni, Master Level IET (Integrated Energy Therapy) Instructor.
Please print these 2 pages, thoughtfully read them in full, fill in the blanks, sign, send, email or bring them with you to your initial session and give them to me.
- I understand that Greg Bottoni does not diagnose disease, illness or mental disorder nor does offer or prescribe medical treatment or pharmaceuticals of any type that you see a Medical Doctor for (physical or mental ailment).
- I understand that the State of New York issues licenses to health and wellness professionals authorizing them to analyze, assess, diagnose, evaluate, examine and investigate their patients to determine what’s wrong with them. This license also authorizes them to advise, caution, counsel, guide, prescribe, recommend and suggest cures, drugs, interventions, remedies and treatments to address what’s wrong with them. I understand that Greg Bottoni will refer me to a properly licensed professional if I need – or if I feel I need – a specialist to diagnose, treat, counsel or cure me of anything.
- I understand that Greg Bottoni cannot make any specific claims regarding the results I may experience.
- I understand Greg Bottoni is a Licensed Spiritual Healer/Spiritual Health Coach qualified to help me identify and remove my spiritual separations and disconnections from the Divine so the Divine will heal me on every level of my being.I understand Greg Bottoni is able to help me diagnose and treat my own spiritual sickness and spiritual issues that are manifesting as pain or stress in my life.
- I further understand that my experiences during our sessions are confidential and everything Greg Bottoni learns about me is confidential except when the law demands that this confidentiality be broken, including knowledge of the commission of a felony, misdemeanor, or breaking of the law, threats of committing suicide, and threats of doing violent crime to others.
- I further understand that Greg Bottoni will release records with my (the clients) written permission.
- I understand that the purpose of Spiritual Healing / Coaching is to facilitate harmony and balance in my energy system allowing my body’s innate tendency for healing to occur and further understand that these Spiritual Healing / Coaching sessions are not diagnostic nor do they guarantee any cures, and Greg Bottoni will not interfere with any directions from a qualified healthcare provider nor does he suggest that Energy Healing / Spiritual Healing or Coaching is a substitute for medical examinations or any medical diagnosis or injuries
- I understand that if I have -- or if I think I have -- a medical concern, condition, disease, disorder, issue or symptoms, or if I think I have -- a psychological or emotional concern, condition, disease, disorder, issue or symptoms, Greg Bottoni will help me reduce any related stress and refer me to a licensed chiropractic, medical or osteopathic physician for further assistance or a licensed counselor, psychologist or psychiatrist for further assistance.
- I understand Greg Bottoni will not accept responsibility for my decisions and he will not make my decisions for me. I understand I am responsible for my own decisions regarding my health, nutrition, wellness and any interventions I decide to try.
***I acknowledge that I have read and understand this form. I agree to allow Greg Bottoni to help me learn to heal myself using the natural healing modalities and techniques and accept Divine Healing herein listed***
I have read & understand the above (initials) __________________Date____________________
Signed in Agreement (signature)_______________________________Date_________________
Print Name ____________________________________________________________________
State/Province __________________ Postal Code ____________ Country ___________________
Relationship to Client (If Other Than Client)_____________________________________________
Home Telephone Number________________________CellularNumber______________________
Parent/Legal Guardian Signature________________________________Date_________________
****Please note if you are a minor, the adult parent or guardian needs to sign the consent form. ****
Thank you and Namaste to You!!!