Consent Form

ACKNOWLEDGMENT OF SERVICES
I understand that Vicki Rasmussen of True North Alignment is a Certified Practitioner in: Usui Reiki, Integrated Energy Therapy® (IET), Angel Therapy, Spiritual Response Therapy (SRT), Spiritual Restructuring (SpR), Lightbody Activation & Integration practitioner, Multi-Dimensional Self™ (MDS) practitioner, Soul Contract Reading practitioner, a Registered Certified Yoga Teacher, and a Meditation/Mindfulness Teacher. She may incorporate any of these therapies as part of sessions/recommendations and utilizes during individual sessions via in person, phone or online sessions.

I understand that the above modalities can assist me in:

• Learning to relax to reduce stressors
• Breathing Techniques, Meditation, Manage my pain
• Improve my mental functioning & enhance my quality of my life through recognizing my inner tools and resources to be more empowered to make more informed decisions with my health and wellbeing in a more positive direction
• Provide yoga poses and techniques to release physical tension and tightness and progress in improving my range of motion

 

PROFESSIONAL THERAPEUTIC RELATIONSHIP GENERAL INFORMATION

I understand this is a professional therapeutic relationship and it is uniquely and highly personal, at the same time is a contractual agreement. Given this, it is important for us to reach a clear understanding about how our relationship will work, and what each of us can expect. This consent will provide a clear framework for our work together.

I understand that Vicki Rasmussen of True North Alignment cannot promise that my behaviour or circumstance will change, however I understand she will do her very best to understand me and any repeating patterns, as well as to help clarify what it is that I want for myself.

I understand that my treatment plan depends largely on my willingness to engage in this process, which may at times, results in considerable discomfort. I might experience emotional issues while I am healing myself in any of my sessions with Vicki Rasmussen of True North Alignment, and remembering unpleasant events and becoming aware of feelings attached to those events can bring on strong feelings of anger, depression, anxiety, etc. There are no miracle cures, nor can I blame my discomforts as I have understood that is part of therapy.

I understand that Reiki and IET is a stress reduction and relaxation technique. I acknowledge that sessions administered are only for the purpose of helping me relax and to relieve stress. A practitioner in ANY of the modalities DO NOT diagnose conditions, nor do they prescribe substances or perform medical treatment, nor interfere with the treatment of a licensed medical professional. It is recommended that I see a licensed physician, or licensed health care professional for any physical or psychological ailment or condition I may have.

I understand the body has the ability to heal itself, and to do so complete relaxation is often beneficial. Long-term imbalances in the body require multiple sessions to allow the body to reach the level of relaxation necessary to bring the system back into balance. I understand and believe that self-improvement requires commitment on my part, and that I must be willing to change in apositive way if I am to receive the full benefit from any of these modalities.

I acknowledge my commitment to my self-improvement process. I recognize that any healing session program must be followed to be truly effective, just as prescribed medication is only effective if taken as directed.

I also understand that I must disclose any mental health or medical diagnosis or discomforts that I’ve experienced in the past or presently to ensure my therapeutic needs are being customized appropriately for me.

I understand that Vicki Rasmussen of True North Alignment is not to be used as a scapegoat during/outside of session time, therefore I understand that I will not blame in person or other forms of communication such as email/text her inappropriately for any discomforts experienced during/outside of session time.

I understand that any sessions through phone or online devices are NOT to be recorded without first asking permission from Vicki Rasmussen of True North Alignment and to state the intention of wanting to record a session.

I acknowledge that all of the modalities listed in this form are not medical procedures, nor is it a practice of medicine and that it consists of voluntary consent on my part.

TELEPHONE ACCESSIBILITY

I understand that if I need to contact Vicki Rasmussen of True North Alignment between sessions,I can leave a message on her voice mail or email her.
 
There will be NO TEXTING for any issues, concerns or questions. TEXTING IS ONLY ALLOWED FOR APPOINTMENT SCHEDULING.
 
I understand that Vicki is not often immediately available; however, I understand Vicki Rasmussen will make the attempt to return my call/email within 36 hours. Hence, I will make use of the afterhours/after session resources (SOS Crisis Line, 911, local emergency facilities).
 
Any messages sent after 9 pm will not be reviewed till till the following day.

I understand that it is best to discuss concerns at my appointed session.

 ELECTRONIC COMMUNICATION

I understand that Vicki Rasmussen of True North Alignment cannot ensure the confidentiality of any form of communication through electronic media, including text messages. Communication via email or text messaging are only permitted for issues regarding scheduling or cancellations; while Vicki Rasmussen may try to return messages in a timely manner within 36hrs during business times, Vicki Rasmussen cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

MINORS

I understand that if I am a minor, my parents may be legally entitled to some information about my therapy. Vicki Rasmussen will discuss this with me, and my parent’s what information is appropriate for them to receive, and which issues are more appropriately kept confidential.

SESSION PAYMENTS

I agree to present payment directly before/after services rendered.
I understand that should I choose to purchase a discounted session package they have an expiry from the date of purchase based on the package purchased. 
  
A 3-session package must be used within 6 months from time of purchase.

A 5-session package must be used within 1 year from time of purchase.

In order to hold accountability and continue inmy healing growth, otherwise they are forfeited after the expiry. It is my responsibility to keep track of my sessions and not the responsibility of Vicki Rasmussen of True North Alignment.

I understand that the time of sessions involve:  
Initial Sessions can be from 50-80 minutes
* This includes new modality sessions that must be introduced to the client
Recurring Sessions are 50-60 minutes in length

I understand that I must be on time for my appointment and there will be no extra time provided at the time the session is scheduled to be over. 

If I am late for a session, I understand I may lose some time during that session time. If it is a disruption to the session it can conclude in a loss of session (ie. 20-30 min left in a session is not sufficient for healing sessions and discussing matters that require more processing time).

NO REFUND POLICY IN EFFECT

I understand that there is a no refund policy in effect. I also understand and accept that expired sessions will not be refunded or honored.

Only for yoga/meditation classes/workshops, is there a refund if 24-hour notice is given for cancellations. This does not apply to one- on- one yoga/meditation classes requested by individual.

CANCELLATIONS, NO SHOW POLICY & PUNCTUALITY

I understand and agree that I must provide at least 24 hours’ notice of cancellation or re-scheduled session or I forfeit the value of that session. i.e. I will be charged/lose a session from my package.

CONFIDENTIALITY & RESPONSIBILITY
I understand that I am responsible for my own health, healing and wellbeing. I also understand I have the ability to heal myself by reconnecting to the Source of all healing, I understand it is my responsibility to advise Vicki Rasmussen of True North Alignment of anything that might help us work together better to achieve the healing I seek. I further understand any services performed by Vicki Rasmussen of True North Alignment are not a substitute for adequate medical care and I intend to remain under the care of my primary healthcare provider.
I understand that if I have -- or if I think I have -- a medical/psychological or emotional concern,condition, disease, disorder, issue or symptoms, Vicki Rasmussen of True North Alignment will help me reduce any related stress and consult with or refer me to other professionals in their areas of expertise in order to provide the best treatment for me.

Yoga

If I am participating in a Yoga class/workshop or where yoga postures are incorporated in healing sessions, I understand that yoga includes physical movements as well as an opportunity for relaxation, stress reduction and relief of muscular tension. I understand I will receive information and instruction, including verbal and physical adjustments about yoga and health. As is the case
with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. It is my responsibility to consult with a physician prior to my participation in the yoga class.

I represent and warrant that I am physically fit, and I have no medical condition that would prevent my full participation in the yoga class. I am aware I may be physically adjusted. I agree to take full responsibility for any risks, loss, claim, injury, damage or liability, known or unknown, which I might
incur as a result of participating in the program.

Yoga is not a substitute for medical attention, examination, diagnosis or treatment. Yoga is not recommended and is not safe under certain medical conditions. I affirm that I alone am responsible to decide whether to practice yoga. I knowingly, voluntarily, and expressly agree to accept full responsibility and assume the risk for my use of or participation in any and all classes, activities, apparatus, appliance, facility privilege or service, of any nature, which is owned or operated by Vicki Rasmussen of True North Alignment. While engaging in any class or activity
operated, organized, arranged or sponsored by Vicki Rasmussen of True North Alignment, either on or off their premises, I shall do so at my own risk and hold Vicki Rasmussen of True North Alignment and associated members, forever harmless from any and all loss, claim, injury, damage, or liability sustained or incurred by me. 

I understand that Vicki Rasmussen of True North Alignment will seek required law & medical attention/other professionals when my health and safety is in jeopardy; or I present imminent threat to myself or others; or if there is in indication of abuse of a child, elder or dependent adult; or if I become gravely disabled. I agree that I am here on my own behalf and not as an agent for any federal, provincial, municipal or professional agency on a mission of entrapment or investigation.

I understand if we see each other accidentally outside of the therapy office, Vicki Rasmussen of True North Alignment may not acknowledge me first. It is my right to privacy and confidentiality and is of the utmost importance to Vicki Rasmussen, as she does not wish to jeopardize your privacy.

However, if I acknowledge Vicki Rasmussen first, she will be more than happy to speak briefly with me, however, Vicki Rasmussen feels it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.