Client Consent Form

ACKNOWLEDGMENT OF SERVICES

I understand that Colwyn Meredith of Reconnecting Self is a Certified Practitioner in: Reiki,MDS, Soul Contract Readings & Overlay Readings.

He 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
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 techniques to release physical tension and tightness and progress in improving my range of motion

I understand that Reiki 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. Reiki, MDS and Soul Contract Reading Practitioners 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 also 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 a positive way if I am to receive the full benefit of Reiki, MDS and Soul Contract Reading.

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

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 Colwyn Meredith of Reconnecting Self cannot promise that my behaviour or circumstance will change, however I understand he will do his 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
Colwyn Meredith of Reconnecting Self, 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 it can be part of therapy.

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 Colwyn Meredith 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 for any discomforts experienced during/outside of session time. Communication is always welcome when done with respect and consideration. 

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

 Reiki & MDS Treatment Positions (Hands-on or Floating)

Please note that Colwyn's Reiki & MDS practice is generally a hands-on healing practice. While there is a protocol of hand positions, he also work intuitively as to where to place his hands and which hands positions to use. His hands will rest lightly on your body and there is no manipulation of your body. If, at any time, you are uncomfortable, he can switch positions, or use the floating hands method.

There is no difference in the benefit experienced by the placement of his hands on your body versus floating his hands over your body. Should you desire to alternate positions during the treatment, please feel free to ask him to do so.

APPOINTMENT SCHEDULING

I understand that Colwyn Meredith is not often immediately available; however, I understand Colwyn Meredith will make the attempt to return my email within 48 business hours. Hence, I will make use of the afterhours/after session resources (SOS Crisis Line, 911, local emergency facilities).

Any messages sent after 5 pm will not be reviewed till the following day. I understand that it is best to discuss concerns at my appointed session.

I understand that if I need to contact Colwyn Meredith between sessions, I will email him. There will be NO TEXTING or phone calls for any issues, concerns or questions.

ELECTRONIC COMMUNICATION

I understand that Colwyn Meredith of Reconnecting Self cannot ensure the confidentiality of any form of communication through electronic media, including text messages. Communication via email is only permitted for issues regarding scheduling or cancellations; while Colwyn Meredith may try to return messages in a timely manner within 48hrs during business times, Colwyn Meredith 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. Colwyn Meredith will discuss this with me, and my parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

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.

CONFIDENTIALITY & RESPONSIBILITY

I understand that I am responsible for my own health, healing and wellbeing. I also understand it is my responsibility to advise Colwyn Meredith of Reconnecting Self of anything that might help us work together better to achieve the healing I seek. I further understand any services performed by Colwyn Meredith 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, Colwyn Meredith 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.

I understand that Colwyn Meredith will seek required law & medical attention/other professionals when my health and safety is in jeopardy; or I present an imminent threat to myself or others; or if there is an indication of abuse of a child, elder or dependent adult; or if I become gravely disabled.

I understand if we see each other outside of sessions,Colwyn Meredith may not acknowledge me first. It is my right to privacy and confidentiality and is of the utmost importance to Colwyn Meredith, as he does not wish to jeopardize your privacy. However, if I acknowledge Colwyn Meredith first, he will be more than happy to speak briefly with me, however, Colwyn Meredith feels it appropriate not to engage in any lengthy discussions in public or outside of the office.

CANCELLATIONS, NO SHOW POLICY & PUNCTUALITY

I understand and agree that I must provide at least 48 hours’ notice for cancellations or to re-scheduled a session or I forfeit the value of that session. 

ACCEPTANCE OF INFORMED CONSENT

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. By signing below, I further agree that I will not hold Colwyn Meredith of Reconnecting Self responsible should there be any unfavorable outcome or result.

I have read the above noted consent and have had the opportunity to question the contents and my therapy. By signing this form, I confirm my consent to treatment and intend this consent to cover the treatment discussed and any additional treatment as proposed by my therapist to deal with my physical condition(s) for which I have sought treatment. I understand that at any time I may withdraw my consent and treatment will be stopped.

SESSION PAYMENTS

I agree to present payment directly at time of booking.The sessions must be used within a year from term in order to hold accountability and continue in my healing growth, otherwise they are forfeited after the expiry.

I understand that the time of sessions will generally be one hour, but can be shorter or longer as each client is unique. 

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 will lose 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 scheduled appointment is not sufficient enough to engage with you, making it impossible to review matters that require more processing time.