I understand Deborah Chan is a Registered BioEnergetic Intolerance Elimination (R. BIE) Practitioner who is allowed to perform all services contained within the scope of practice for her registration. I also understand as a R. BIE Practitioner, she uses BioEnergetic Intolerance Elimination (BIE) to help my body adapt to intolerances by stimulating and clearing any blockages in energy, which helps the body to achieve homeostasis (balance) and will improve the quality of life.
I understand that I am responsible for my own health, healing and well being. I also understand I have the ability to heal myself. I further understand BIE is not a substitute for adequate medical care and I intend to remain under the care of my primary healthcare provider.
I further understand that I might experience some discomfort as my body detoxifies while I am healing myself. I understand all healing may cause me some minor discomfort and some adverse side effects, such as a headache, skin rash, or tiredness may occur through no fault of myself or Deborah Chan.
I also understand some interventions are contraindicated by the manufacturer and I will be fully advised of these contraindications. If I have any concerns about these things, I will keep Deborah Chan fully advised about my concerns so the intervention may be terminated if necessary or revised to minimize any harm to me. I further understand these services may have no effect on me.
I also understand that I should not for any reason, ingest or expose myself to any substance that I have previously been diagnosed as allergic or anaphylactic by a qualified physician/allergist, or if I am aware of any severe allergy to a substance, unless I have first been given consent by a qualified physician/allergist.
I understand that my health and healing is my responsibility; and I choose to use the holistic healing services of Deborah Chan to help me heal and improve my health. I understand my identity and any information about me, whether I share it with Deborah Chan or she discovers it on her own, will be held in the strictest confidence, except when released by me or specifically required by law. I have the right to waive this confidentiality agreement in whole or part at any time.
I acknowledge that I have read and understand this form. I agree to allow Deborah Chan to help me learn to heal myself using the natural healing techniques and modalities herein listed.