top of page

Client Authorization

Wellness and/or Energy Therapy

  1. I fully understand that the individual(s) rendering wellness and/or energy therapy services are not medical or osteopathic physicians, or other licensed health care practitioners, and do not portray themselves to be, but are wellness consultants and/ or Biofeedback providers.

  2. I fully understand that there is a difference between the practice of allopathic (M.D.) or osteopathic (D.O.) medicine, holistic practitioners, and energetic and Biofeedback consultants.

  3. I fully understand that the services provided are not medical care but are strictly nonmedical Bioenergetic or Biofeedback services.

  4. I fully understand that the individuals rendering the wellness or energy therapy services perform the services within the parameters of natural wellness care using Biofeedback and stress reduction or other energy therapies.

  5. I fully understand that the individuals rendering the services do not offer medical or pharmaceutical drugs, surgery, chemical stimulants, radiation therapy or any other conventional medical treatments. In addition, he/she does not diagnose, treat or otherwise prescribe for my disease, conditions or illnesses.

  6. I fully understand that my energy and stress parameters are being measured.

  7. I presently seek counsel, advice, opinions related to energetic balancing, stress management or Biofeedback within the scope of, and limited to, a wellness and stress reduction practice. I authorize the individuals rendering services to perform Biofeedback and/or energy assessments and lifestyle recommendations.

  8. I fully understand that the services provided are in the emerging field of Bioenergetic therapy, and may not be used by medical practitioners.

  9. By signing below I acknowledge that I have read and understand all parts of this authorization and that I have the opportunity to ask any questions with regard to any services or therapies offered.

Thanks for submitting!

bottom of page