Confidential Client Information for Energy Healing Work

Thank you for choosing me for your energy healing sessions.  To provide you with the best experience possible, I request that you fill out the information in this form as honestly as possible.  Some of the information that I ask for here is recommended by worldwide practitioner organizations, and some is required by health governing bodies.  The more detailed and specific you can be in your responses, the clearer my view of your energetic body will be and the easier I can zone in on, and support you with, the areas of life that are important to you.

Your information here is strictly confidential, and its privacy is governed by HIPAA, the U.S. Health Insurance Portability and Accountability Act of 1996.  I do not share your information with anyone or any entity, period.

-Beth
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What Type of Energy Sessions, if Any, Have You Received in the Past?
A Few Medical Details

In-Person Practice Information and Possible Issues

If we are having an in-person session, I may have you lying face-up and face-down on a massage table and I may use light physical touch.  I may also use aromatherapy with essential oils.  You can skip this section if you don't ever expect to have an in-person session.

WHAT ENERGY HEALING IS, WHAT IT IS NOT, AND WHAT TO EXPECT

I incorporate different techniques of energy healing in my practice, driven by client needs and what I hear to do from spirit.  Some of these techniques are formalized practices, and some are part of what I personally bring to a session.  Here are two formalized techniques that I am certified to practice:

Reiki is a spiritual healing art with its roots in Japanese practices.  It is not a massage technique, nor is it based on belief or suggestion; instead, it is a subtle, effective form of energy work using Spiritually-Guided Life Force Energy.

Theta Healing® is a meditational process that creates physical, psychological, and spiritual healing with focused prayer through the Creator.  When we connect to the Creator of all that is, our brain waves automatically go into a Theta state of mind.  In this state, you can create anything and change reality.

Energy healing, in all its forms, promotes healing of the energetic body that exists in all of us.  This energetic body exists simultaneously with our physical body, with each having a direct effect on the other.  Energy healing therapies can help us mentally, spiritually, emotionally, and physically, including:

  • Relief from stress and anxieties by balancing the energetic structures, the Chakras, throughout the body.
  • Detecting and removing energy blocks that may be at the root of physical, mental, and emotional stresses.
  • Complementing and possibly enhancing traditional medicinal healing therapies and rehabilitation.
  • Clearing the mind for effective decision-making and being at peace with situations.
  • Increasing intuition for, and sensitivities to, the world around us.

No energy healing practice is a substitute for established medical care.  It has been shown that energetic healing arts can complement and enhance the effectiveness of medical treatments, and you are strongly encouraged to continue all treatments and medications provided to you by a physician.

Remain as relaxed as possible after your session.  Drink lots of water and eat natural, unprocessed foods to help balance your physical energy levels.  You may notice a shift in your sleeping pattern, leaving you tired or energized.  You are encouraged to journal your experiences and share them with your practitioner at your next session to help make slight course corrections to your line of treatment.  Reach out to your practitioner with any questions or concerns that you have.

DISCLAIMER, WAIVER AND RELEASE

The following statements refer to the professional practice of Beth A. Pfeffer, Angelic Soup, LLC., its owners, partners, successors, lessors, employees, and assigns; hereinafter referred to, individually or collectively, as Energy Healing Practitioners.

By providing my electronic signature below, I hereby accept, understand, and confirm that Energy Healing Practitioners do not diagnose illness, disease, or mental disorders, nor do they prescribe medical treatment or pharmaceuticals.  I also affirm that it has been made clear to me that the practice of Energy Healing is not a substitute for medical examination, diagnosis, or treatment, and that it has been recommended to me that I consult with a medical practitioner such as an M.D. or N.D. for any physical or mental ailment that I may be currently experiencing or may experience in the future.

Consequently, I agree and affirm that Energy Healing Practitioners cannot be held liable for any problem, real or imagined, that might arise as a result of participating in Energy Healing sessions.  I also affirm that I have provided a true and complete representation of my physical, emotional, and mental health by way of disclosure above and will update such information with my practitioner as conditions change or as necessary.

I understand and affirm that Angelic Soup, LLC., its owners, partners, successors, lessors, employees, and assigns hereby disclaim any and all representations of efficacy for any treatment(s), specific outcomes, or results.  I agree to release, indemnify, and hold harmless Angelic Soup, LLC., its owners, partners, successors, lessors, employees, and assigns from any claims of injury, malpractice, non-disclosure, or lack of informed consent.

I furthermore affirm that I understand the nature of the treatments imagined by Energy Healing practices and freely elect to receive those treatments.  I agree that I have been given enough opportunity to ask questions and make specific requests to make my treatment time as comfortable as possible.  Lastly, I agree to abide by all policies set forth by Angelic Soup, LLC., and/or its lessors.  For in-person sessions, I agree to abide by all sanitary and safety provisions that are mandated by authorities and set forth by Angelic Soup, LLC.