Client Agreement & Disclosure Statement
Thank you for your interest in working with me as a client for Energy Medicine and Intuitive consulting. I am providing you with the following information so you can make an informed choice about your decision to engage my services. Please read this information carefully and let me know if there is any part you do not understand. Although I will share my skills and abilities to support your growth, intuitive awareness, and tools for your personal and/or professional development, my work with you is only a resource. As an intentional and conscious participant in your growth, you will ultimately take all responsibility for and actions related to furthering the evolution of your life journey.
As a Intuition Medicine practitioner and Energy Medicine worker, I offer innovative energy-based coaching and self-help techniques combined with intuitive skills based on the newly emerging field of energy medicine (the “Energy Techniques”). Energy Techniques is a collective term used to refer to a variety of alternative and complementary treatments based on the use of intuitive skills and the use, modification, and manipulation of energy fields. The prevailing premise of the Energy Techniques is that the flow and balance of the body’s electromagnetic and more subtle energies are important for physical, spiritual, and emotional health, and for fostering well-being. Although the Energy Techniques appear to have promising emotional, spiritual, and physical health benefits, they have yet to be fully researched by the Western academic, medical, and psychological communities and therefore, may be considered experimental. The Energy Techniques are self-regulated and the State of California does not license any Energy Technique practitioners and considers the Energy Techniques to be “alternative” or “complementary” to the healing arts that are licensed by the State of California.
If you ever have questions or concerns about the nature of the theories and methods I use, please feel free to ask me for further resources or references.
Nature of the Relationship
Please be advised that I only offer my services as a consultant and mentor. I’m not a psychologist, psychotherapist, physician, or other licensed health care provider nor are my services licensed by the State of California. Under Sections 2053.5 and 2053.6 of California’s Business and Professions Code, I can offer you my services, subject to the requirements and restrictions that are described fully in the attached Client Information Sheet incorporated herein by reference and made part of this Client Agreement and Disclosure Statement. You understand my work with you as an intuitive practitioner is not intended to be used to diagnose, treat, cure, or prevent any disease or psychological disorder; our sessions together do not replace health care professionals. You agree to consult with your health care provider for any specific health care problems.
Risks and Benefits
Please note that it is impossible to guarantee any specific results regarding your goals using the Energy Techniques and intuitive coaching. However, we will work together to achieve the best possible results for you. Most clients report positive outcomes using the Energy Techniques and intuitive coaching for resolving many types of challenges and issues. However, in using the Energy Techniques and intuitive coaching as part of our sessions together or on your own between sessions, it is possible to experience some emotional distress and/or physical discomfort that can be perceived as negative. Unresolved memories may also surface and emotional material may continue to surface after a coaching session and give indication of other issues or incidents that may need to be addressed. You agree to promptly inform me if you experience any emotional distress and/or physical discomfort during our work together, particularly between our sessions. If appropriate, I can help refer you to an appropriate professional health care provider for further assistance. Regardless of our work together, you agree to take full responsibility for your self-care in the emotional, mental, physical, and spiritual dimensions of your life.
Fees and Payments
$150 per session
Scheduling of appointments involves the reservation of time specifically for you. Therefore a minimum of 48 hour advance notice is required for rescheduling or canceling an appointment. The full fee or half fee may be charged for missed appointments without such notification.
I will not release any information to anyone without a written authorization from you, except as required by law. You have the right to be allowed access to any my written record about you. Please be advised that I do not have confidentiality in court. If you are in litigation, your sessions are not confidential.
Education and Training
I have earned a Master Certificate in Intuition Medicine® MIM from the from the Academy of Intuition Medicine® in 2009, where I studied with the founder, Francesca McCartney PhD.
In 2006, I attained the Third Degree certificate as a Reiki Master in the Usui system of Natural Healing, at the Sonoma County Center for Reiki.
From 1979-1989 I studied and practiced the Simonton Method of guided meditation under the direction of Jan Bergman of the founder of Cancerport and Grief Support in Marin County, CA.
The Academy of Intuition Medicine® is approved by the California Bureau for Private Postsecondary Education. For more information, please visit http://www.intuitionmedicine.com/academy/certificate.htm
Acknowledgment and Consent to Receive Services
By booking a session, you agree that I have disclosed to you sufficient information to enable you to decide to undergo or forgo the Energy Techniques and intuitive coaching I offer. You have considered all of the above information and have obtained whatever information or professional advice you deem necessary to make an informed decision and understand that I am not a licensed physician or mental health professional and that my services are not licensed by the State of California.
You understand that your consent to the nature of our intuitive coaching sessions is given voluntarily, without coercion, and may be withdrawn at any time in the future. You represent that you’re competent and able to understand the nature and consequences of the proposed intuitive coaching sessions. You understand it is your responsibility to maintain a relationship for yourself with an appropriate professional health care provider. You have consented to use the services offered by me and agree to be personally responsible for the fees related to the services provided to me. By booking a session, you knowingly, voluntarily, and intelligently assume these risks and agree to release, indemnify, hold harmless and defend Dee Merz and her agents, consultants, and employees from and against any and all claims of whatsoever kind or nature, which you, or your representatives, may have for any loss, damage, or injury arising out of or in connection with your sessions.