Informed Consent

Shanti Saltzman, MA, MIM

Intuition Medicine® Practitioner

Please read the following statements:

 

1. I understand that I am seeking counseling services from the individual named above, and that this practitioner is not a physician.

 

2. I understand that the services I am seeking are defined as “alternative” or “complementary” to health services that are licensed by the state of California.

 

3. I understand that the services to be provided are not licensed in the state of California.

 

4. I understand that the nature of services being provided is as follows:  verbal counseling on issues presented by client(s), with an emphasis on spirit-to-spirit communication and energetic healing in the Intuition Medicine® modality.  A basic premise of the Intuition Medicine modality is that healing is accomplished by grounding one’s spirit in alignment with the physical body.  I may, therefore, experience physical sensations during sessions though the practitioner will not physically touch me as part of the work.  I agree that I will communicate any physical discomfort or unease to the practitioner immediately if it presents in session.

5. I understand that I am seeking services from a practitioner whose theory of healing incorporates the premise that personal growth is accomplished through attention to the spiritual aspect of one’s being, as well as the physical and emotional/psychological processes.  Therefore, all of these areas may be addressed in sessions with this practitioner.

 

6. I understand that I and the practitioner may discuss matters of a deeply personal nature, and that I have the right to question, dismiss or disagree with statements made by the practitioner if I am not comfortable with them or they do not resonate with me.

 

7. I understand that following sessions I may feel an increased sense of well-being.  I also understand that work with this practitioner may bring about the release of old emotions such as grief, sadness or anger as part of the healing process.  The process may also bring my attention to outdated energetic patterns in my life, including but not limited to, relationships with family, friends and work.

8. I understand that the SCIO biofeedback device does in no way claim to "heal" or "cure" illness or disease and that I am ultimately responsible for my own body and my own healing.  The SCIO™ is to be used as a universal electrophysiological biofeedback system. It is designed for stress detection and stress reduction. The device does not diagnose any issue other than stress. Stress can come from many sources; this system uses many multimedia therapies to reduce stress. This device also measures client's electrophysiological reactivity which is another way to represent stress. Only a licensed healthcare practitioner can diagnose a client. The system is calibrated to measure the very fine and subtle electrical reactions to a group of biological and medical stressors. The sensitivity is set so fine so as to pick up the earliest sign of distress and issues related to distress. Therefore, the results might be below the client recognition. The readings should be evaluated by trained biofeedback technicians. Always consult with a licensed healthcare practitioner. Always use additional tests or referrals. No claims other than stress detection and stress reduction may be made.

 

9. I understand that Shanti has been trained in the following modalities: Trained as a Technician on the SCIO biofeedback device and trained in Intuition Medicine® (Master of Intuition Medicine®, Academy of Intuition Medicine® Diploma 2014).  This diploma is approved by the State of California as a Vocational Diploma giving Shanti career approval to work as a Medical Intuitive, Spiritual Coach and Intuition Medicine® Consultant.

By signing this document, I am consenting to work with this practitioner as indicated above.

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