Informed Consent Form for Marie-Anne Bisson
Certified Hypnotherapy, Spiritual Coaching, Mediumship readings, Card readings and Reiki Master
I understand that Marie-Anne Bisson is a Certified Hypnotherapist, licensed Spiritual Health Coach, certified Reiki Master Practitioner, and a Medium.
The Spiritual Health Coach License Board licenses qualified spiritual healers to help other people heal themselves. Licensed Spiritual Health Coaches are charged with the responsibility of coaching people with physical, emotional, mental, psychological (intuitive) and spiritual problems. This charge is to help others heal themselves not by telling them what to do, but by helping them through a process whereby they can make their own decisions. This process is called coaching. The person who facilitates the process resulting in abundant spiritual health is a spiritual health coach.
I understand Marie-Anne Bisson is a Reiki Master, qualified to help me make more informed decisions about my own life and health care. I understand that Reiki can complement any medical or psychological care I may be receiving. Light touch is used on or above the client’s clothed body. I also understand that the body has the ability to heal itself and to do so complete relaxation is often beneficial and may sometimes require multiple sessions in order to achieve that level. I also understand that Reiki can help me reduce my stress, relax, manage my pain, and improve the quality of my life.
I understand that the Province of Manitoba issues licenses to health care professionals. This license authorizes them to analyze, assess, diagnose, evaluate, examine and investigate their patients to determine what's wrong with them. This license also authorizes them to advise, caution, counsel, guide, prescribe, recommend and suggest cures, drugs, interventions, remedies and treatments to address what's wrong with them. I understand that Marie-Anne will refer me to a properly licensed professional if I need, or if I feel I need a specialist to diagnose, treat, counsel or cure me of anything. I understand spiritual healing is not a substitute for medical treatment and realize that it is my responsibility to continue ongoing medical treatment and therapies until otherwise advised by my primary physician.
I understand that the natural healing techniques provided by Marie-Anne Bisson are used for stress reduction and relaxation. I Marie-Anne Bisson will not accept responsibility for your decisions and will not make your decisions for you. You are responsible for your own decisions regarding your health, nutrition, wellness and any interventions you decide to try.
I understand that if I have, or if I think I have a medical concern, condition, disease, disorder, issue or symptoms, Marie-Anne Bisson will help me reduce any related stress and refer me to a licensed chiropractic, medical or osteopathic physician for further assistance.
I also understand if I have, or if I think I have a psychological or emotional concern, condition, disease, disorder, issue or symptoms, Marie-Anne Bisson will help me reduce any related stress and refer me to a licensed counselor, psychologist or psychiatrist for further assistance.
I understand that Marie-Anne Bisson will keep all information she learns about me completely confidential unless I release her in writing or as required by law. I further understand that Marie-Anne will not acknowledge my presence or discuss anything with me publicly unless I initiate the conversation and the topics of discussion.
I understand that Marie-Anne Bisson is not responsible for any lost or mishandled emails and that she has the right to refuse service if she feels it not to be safe or find it unsuitable. I understand that readings requested to be done by email are personally done by Marie-Anne Bisson and sent to me by email based on a 1st come, 1st served basis. I understand that Marie-Anne Bisson may sometimes include at no extra charge, but does not promise to include, Angel card, tarot or runes readings for clarity. I understand that I am to check my spam/junk folder for receipt of the email. I understand that fees will only be processed once the reading has begun. Once reading has begun, no refunds will be offered. I understand that for tarot/runes readings and Mediumship, it is important to note that impressions received are as perceived and interpreted by Marie-Anne Bisson. I understand that there may be instances where another familiar spirit other than the one requested from the client that may come through to communicate. Clients may find messages and symbols that resonate with them and should listen to what speaks to them. I understand that Marie-Anne Bisson is not responsible for the consequences of my actions with regards to my personal interpretation of these readings. I understand that all readings are deleted 5 days after Marie-Anne Bisson sends me the file by email.
Fees & Payments
(Please visit my website for more pricing details at www.thespiritualdoorway.ca)
I understand that I will be charged (Prices vary for Hypnotherapy, $45 for Spiritual Health Coaching, $85.00 for Mediumship, $30 for full tarot/runes/angel card readings, $25 for a ½ hour or $45 for an hour Reiki treatment) and that all payments are due at time of service by cash, prepaid via PayPal ($3 service charge applies to all PayPal orders) or E-transfer. For private appointments, I understand that I will be invoiced for the full value of my session if I cancel within 24 hours. I understand that Marie-Anne Bisson does not have a refund policy after I receive my services and as for private sessions, will honour my refund request if received over 24 hours prior to my appointment. (Exemptions apply if the circumstance is weather related for private sessions only.) I understand that all NSF cheques will be charged a $25 fee.
I acknowledge that I have read and understand this form. I agree to allow Marie-Anne Bisson to help me learn to heal myself using the natural healing techniques and modalities herein listed.
Please read the attached document. By typing (electronic signature) or signing your name below, you agree to the terms and to the attached consent form, and that you confirm that this is your electronic signature. (Legal guardians/parents must sign if you are under 18 years of age)
Name:_________________________________________________ Date: _________________
City:________________________ Prov/State:_____________________ PC/Zip:_____________
Home Phone #:_____________________ Work/Cell Phone # :__________________________
Email address: ________________________________________________________________
Date of Birth: Month ____ Day ____
How did you hear about my work? _________________
Signature of Client or parent/legal guardian if under 18 years of age:
(Print name of parent/legal guardian if under 18 years of age)
Payment options: (Mark with an X)
PayPal: ____ ($3.00 service fee applies to all PayPal transactions)
(Check your spam/junk folder)