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Disclaimer Client Form

An Act To Permit Certain Health Care Practices, Sec. 1. 32 MRSA c. 137

Unlicensed Health Care Practitioners

The state of Maine does not require a license to practice Reiki or Energy Healing, therefore, I am not licensed, certified or registered in the state of Maine as a health care professional. I am not a licensed medical physician and do not diagnose, treat or prescribe remedies for the treatment of disease. The services I perform, whether in person, by mail or by phone, are at all times restricted to complementary and alternative health care services intended for the maintenance of the best possible state of general well-being.

 

Further, you understand the services I offer and the use of Reiki/Energy Healing, Meditation, Shamanic Healing, Sound Healing and spiritual guidance are not intended to be a substitute for medical or psychological treatment and they do not replace the service of health care professionals. You agree and understand it is your responsibility to consult with your health care provider for any specific health care problems.

 

By signing this document you understand I am offering my services solely as a Complementary and Alternative Health Care Practitioner and our relationship is not to be construed as medical treatment, psychotherapy, nor is it a substitute for these services.

 

I am prohibited from treating children less than two years of age. In order to treat a child who is between 2-18 years of age, I must have a written, signed consent of the child's parent or legal guardian.

 

The services I, Laura Myers “Lotus” provide are—Reiki Treatments, Distance Reiki, Sound Healing, Shamanic Healing, Trauma-informed Yoga, Breathwork, Somatic Healing, Meditation and Gestalt methods.

 

My relevant professional and therapeutic certification, training, experience and qualifications are as follows:

E X P E R I E N C E :

 

Therapeutic Massage Therapy — The Australian Center for Transitional Health & Healing, 1997-98

Bodywork & Energy Healing — The Australian Center for Transitional Health & Healing, 1998

Advanced Bodywork & Energy Healing — The Australian Center for Transitional Health & Healing, 1999

Tantra Yoga & Meditation for Individuals & Couples — The Australian School of Tantra, 2010-15

Shamanism and the Transformational Mask — Circalore, Sydney, 2011-13

Gestalt Methodology — The Gestalt Institute of the Rockies, Colorado, 2021-on-going

Trauma-Informed Yoga — Exhale to Inhale, New York, 2020

Usui Shiki Ryoho — Usui Reiki System of Natural Healing, Maine, 2023

 

I carry a liability insurance applicable to any injury caused by an act or omission in providing complementary and alternative health care services.

 

A copy of this disclosure statement will be kept on file for at least two years after the last date of service.

 

*As my client, you should discuss any recommendations I provide with your Primary Care Physician, Obstetrician, Gynecologist, Oncologist, Cardiologist, Pediatrician or Pediatric Health Care Provider, or other Board-Certified Physician.

 

I understand that Reiki is a simple, gentle, hands-on energy technique that is used for stress reduction and relaxation. I understand that Reiki practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that Reiki does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that Reiki can complement any medical or psychological care I may be receiving. I also understand that the body has the ability to heal itself and to do so, complete relaxation is often beneficial. I acknowledge that long term imbalances in the body sometimes require multiple sessions in order to facilitate the level of relaxation needed by the body to heal itself.

 

By signing the form below, I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Laura Myers “Lotus”.  Full disclosures of the credentials and training background will be provided upon request. 

 

I am filling out this agreement (below) voluntarily and recognize that my e-signature serves as complete and unconditional release of all liability to the greatest extent allowed by law. 

Client Agreement Form

By ticking the box below you are confirming that you understand and agree to the terms and conditions outlined above.
Thank you
I look forward to journeying with you
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