Thanks for filling out your Intake Form and now we move onto your Consent Form. 

I have received information regarding Healing Touch from Amy Stephens and I understand that Healing Touch is a gentle, complementary energy based approach to health and healing that can assist my body in its natural ability to heal.  I fully acknowledge and understand that this is accomplished through the use of contact and/or non-contact touch.  It has been explained to me, that Healing Touch is a complementary therapy not intended to replace any currently prescribed medical treatments as ordered by my physician nor any other medical practitioner. 

These sessions are not meant for diagnosing or treating any physical or mental disease or condition.  Healing Touch services do not substitute for diagnosis and treatment from a licensed health care practitioner for illness or injury or other medical conditions.   Always speak with your medical practitioner directly about concerns of your health and well-being. 

Confidentiality:

I have been informed that all client information and records provided during a Healing Touch Session will be kept confidential.  Information may not be released to individuals or agencies without my signed authorization.  Practitioners are required by law to report the threat of serious harm to self or others.  Client files are maintained in strict confidence, in accordance with applicable state laws and professional standards. 

Individuals show need for Healing Touch on a few of the following:

  • Reduction in pain, anxiety and stress

  • Decrease in nausea, vertigo and headaches

  • Preparation for medical treatment and surgeries to manage side-effects

  • Support during chemotherapy

  • Supports the body's natural healing process and sense of well-being

  • Facilitation of wound healing

  • Emotional, Mental and Spiritual support

 

 

Client Name *
Client Name
Address *
Address
Phone *
Phone
I have been told the following to expect from my Healing Touch Session: Very light touch will be used on my head, arms, torso, hips, legs and feet. I understand that relaxation is key to receive healing. I understand that Amy calls upons her Guidance to assist her to become the conduit for healing and that I can also call upon my Guidance as well. Healing takes place for Physical, Emotional, Mental and Spiritual levels. I understand that I might feel heat from Amy's hands as well as possible trembling. I understand I can communicate with Amy during our session. *
I like Essential Oils and I am open to having them used during my session. *
Music can sometimes enhance the healing process *
Long Distance Healing Session; you will need to be able to lay down during the scheduled appointment and have a brief call before and after the session.
Fees & Payments for first session *
After our first initial session, I understand that there are 3 packages available for 90 minute sessions. Packages can also be used for AromaTouch, Releasing Old Beliefs and Thai Yoga Massage (done on the floor) and Healing Touch. *
Cancellation Policy - 24 hours notice from appointment time. If a last minute cancellation takes place you will be charged for a full appointment time. *
I understand that there are no refunds on my purchased package of sessions and that there is no expiration date on my purchase. I can not share my package of sessions with anyone else. *
I give my full consent to move forward with my Healing Touch Session and also understand the fee structure for future sessions. *