Thank you for considering working with me (through Modern Dad Mystic LLC (“my” or “us”)) as part of your personal growth process through energy healing and/or spiritually based life coaching.  This document contains important information about this modality and what you can expect.  Please read it carefully.  If you decide to proceed with booking or attending any session, this will represent a formal agreement between us.  

 

Subtle energy modalities are recognized under NCAM, the American National Center for Complementary and Alternative Medicine.  There is a growing body of research literature documenting positive effects from these types of healing treatments. Life coaching is also a growing form of support used by many people. These modality types are not regulated currently by any federal or state agency in the USA.  I am insured for energy healing and education and counseling.  I follow a strict code of ethics that is consistent with professional standards. 

 

WHAT IS ENERGY HEALING?

 

Energy Healing is an approach that involves balancing and restoring your body’s natural energies for the purposes of increasing your vitality, strengthening your mental capacities, and optimizing your health.

 

ENERGY HEALING IS NOT THE PRACTICE OF MEDICINE

 

Energy Healing or Energy Medicine are phrases used by many training programs that teach people how to assess and correct for energy imbalances in the body. Energy Healing/Medicine or life coaching are not substitutes for the diagnosis and/or treatment of medical or mental health conditions by a licensed health care professional. If you have a disorder that has been diagnosed by a licensed medical or mental health professional or a condition that should be evaluated by a licensed health professional, my services should be used only in conjunction with your obtaining that care. I do not diagnose or treat medical or mental health disorders, nor am I trained or licensed to do so. Energy Healing attempts to optimize the body’s overall health and vitality, and life coaching intends to guide people to their most fulfilled lives, but these are not to be used in place of appropriate care from a licensed medical or psychological professional.

 

OUR WORK TOGETHER

 

Description of Services:

Energy Healing or Medicine techniques bring disturbed energies back to a state of balance and harmony.  I serve as a facilitator in your self-initiated process of healing.  These facilitations will generally consist of various forms of discussion, vibrational work potentially including sound (via bowl, tuning fork, or other instrument), light or deeper touch, and movement of my hands within your body’s energy field. If you are uncomfortable with being touched or with any of the procedures being used, please tell me immediately and I will instantly stop.  You will be fully clothed and may be laying on a massage table in a professional, private office. 

 

While these methods are gentle and considered non-invasive, it is possible that physical or emotional after-effects may occur. In some instances, deeper pressure moves energies that may be blocked or congested in a particular area of the body, and this may cause some pain or discomfort.  Most people experience a profound sense of relaxation.  You may sense thoughts, images, or emotions or may recall memories and/or have insights enter your consciousness.  You may feel body sensations such as heat, cold, or tingling.  Emotions may be released that have been stored in the energy field.  Dizziness, nausea, or anxiety are relatively unusual but possible side-effects to energy work. If any procedure leads to discomfort, please tell me at once. I will instantly stop if you request me to do so and can often provide a technique to counter the discomfort.

 

What are the benefits to this type of healing?

There are no guarantees, but research documents evidence of the following potential benefits:

• Decreased stress

• Enhancement of your own body’s healing power

• Mental and emotional clarity and resolve

• Feeling more emotionally balanced and centered

• Quicker resolve of psychological issues

• Improved relationship with self and others

• Opening up to the presence of the Divine within and around you.

• Decreased pain and/or other physical symptoms

• Increased levels of energy

 

 

OTHER ASPECTS OF OUR RELATIONSHIP

 

Confidentiality.  In the course of our work together, we will explore areas that influence your state of well-being.  We may address your health history, life stressors, belief systems, thought patterns, family and childhood history, diet, exercise, dreams, and relationships.  Your sharing will be kept confidential.  I may, however, discuss clients without using names with my professional mentor for the purpose of my professional development and so that participants may receive the most assistance available.  Your confidentiality is always subject to the usual exclusions dictated by state and federal laws and regulations.  You may instruct me to release information to other health care professionals in writing.  Please feel free to discuss our work with your physician, psychotherapist, or others on your health care team.

 

Questions. Please ask me questions about anything that happens in our work together. I'm always willing to discuss how and why I’m doing what I'm doing.

 

Multiple Relationships.  If we have a prior relationship, please know that our work in this capacity will remain separate from any social, professional, or peer relationship.  Anything brought forward through this process will be part of the sacred, confidential container of the healing session.  I will discourage any discussion outside of our sessions.  If you feel that due to our relationship, you are inhibited in speaking freely, please notify me and discuss your concerns prior to starting any session. 

 

Complaints.  If you are unhappy with our work together, I encourage you to talk about it with me so that I can respond to your concerns directly. I will take such concerns seriously and respond to them with care and respect. You may discontinue services at any time.

 

More information is available regarding the history, science, and research related to this kind of healing modality and is available upon request.

 

 

ACKNOWLEDGMENT AND CONSENT 

 

I have read and understand the above disclosure regarding the services offered by Nicholas T. Peters through Modern Dad Mystic LLC.  I understand he is not a physician or psychotherapist.  I understand that Nicholas T. Peters is not trained to diagnose illness, disease, or mental disorders or to make recommendations involving pharmaceutical drugs or surgery or to handle medical emergencies.  It has been made clear that energy healing is not a substitute for medical examination and diagnosis and that I should seek treatment from a licensed health care professional if needed. 

 

I have been informed that energy medicine and life coaching are generally safe methods of treatment but that shifts in energy occur and may create some physical, emotional, or spiritual side effects that may include physical tingling, feeling lighter energetically, mild fatigue, nausea, muscle soreness, headache, light headedness, thirst, changes in relationships, shifts of perception, and the like.  I do not expect the energy practitioner to be able to anticipate and explain all possible risks and complications of energy treatment, and I wish to rely on the energy practitioner to exercise judgment during the course of treatment which the energy practitioner exercises a best and highest interest for healing, based upon the facts then known and for my best interest and highest good.  I understand the results are not guaranteed.

 

I understand that all clinical information and records of our sessions will be kept confidential and will not be released without my written consent.

 

I hereby request and consent to the performance of energy healing modalities and treatments within the scope of practice of Nicholas T. Peters though Modern Dad Mystic LLC.  I understand the method of treatment may include but are not limited to: energy balancing and harmonization, medical intuition, chakra harmonization, energy healing, emotional release techniques, visualizations, meditation, counseling, education, and coaching. 

 

I agree to be personally responsible for the fees in connection with the services he provides no later than at time of service and to give at least 24 hr. notice of any cancelled appointments. No refunds will be provided for sessions canceled with less than 24 hours of notice. Any package of sessions must be used within one year of the purchase of the package.

 

I agree to take personal responsibility for my well-being and with respect for myself; I gratefully accept control of my choices.  I recognize that the degree to which energy can heal depends upon my participation. 

 

By voluntarily beginning or continuing with any session, I show that I have read or have had read to me this consent to treatment and have been told about the risks and benefits of energy healing, medical intuition, and other energy or coaching or counseling modalities and have had an opportunity to ask questions.  I intend this consent form to cover the entire course of my sessions for my present condition and for any future conditions for which I seek treatment from Nicholas T. Peters.  I release Nicholas T. Peters and Modern Dad Mystic LLC from any and all claims of malpractice, non-disclosure, or lack of informed consent.  I am aware that this is a waiver and release of potential liability and a contract between the above noted party  and myself.  I understand this contract is binding and acknowledge that I am signing of my own free will.