Client bill of rights Form

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Complementary and Alternative Health Care
Client Bill of Rights
The following information is provided to you, as required by Minnesota Law.
Please feel free to ask for clarification of this information if needed.
1.
Services Provided by
Theresa A. May and Heaven on Earth Healing
Mind Body Integrative Medicine
The Compass Center for Healing
116 E. Chestnut Street (lower level)
Stillwater, MN. 55082
Heaven On Earth Healing (upper level of the Hillsborough 1 building)
2353 Rice Street, Suite 200
Roseville, MN 55113
Phone:
612-345-1537
Website: www.heavenonearthhealing.com
Email:
theresa@heavenonearthhealing.com
t.may64@gmail.com
2. Education / Certification
Master Hypnotherapy
Master Practitioner of Humanistic Neuro-linguistic Psychology and
Neuro Linguistic Programming
Therapeutic Coach
Reiki master/teacher
Core Shamanism
Qigong healer, Spring Forest Qigong level 4 & completed the SFQ Guide & teachers Certification Program
Practitioner of Traditional Chinese Medicine, Asian Bodywork, Shiatsu Anma,
Instructor of Tai Chi Chih and Spring Forest Qigong Meditation classes
*The state of Minnesota and AOBTA approved professional training program for Asian Bodywork Therapists and
Traditional Chinese Medicine. Minnesota does not currently offer state licensing requirements for Asian Bodyworkers.
3.
Mission: “Supporting the evolution of life through personal transformation”
“My passion is in working with individuals and organizations to improve our world through informing, inspiring and
facilitating healing transformative experiences, through individual and group experiences, in-services, consulting and
wellness program development to organizations.”
“As a therapist, teacher and life long learner I have been privileged to witness profound transformations. Through these
experiences I’ve discovered the key elements that are necessary for deep healing to occur. By applying the wisdom of eastern
healing arts with progressive non-conventional talk therapies one can truly experience profound changes for their whole
being, mind-body and spirit.”
4. Mentorship: I consult with other professionals within my scope of practice as needed.
5. As a Client you have the right to contact me with questions, concerns and complaints.
6. The State of Minnesota has not adopted any educational and training standards for unlicensed complimentary & alternative health
care practitioners. This statement of credentials is for information purposes only. Under MN. Law, unlicensed complimentary and
alternative healthcare practitioners may not provide a medical diagnosis or recommend discontinuance of medically prescribed
treatments. If a client desires diagnosis from a licensed physician, chiropractor, or acupuncture practitioner, or services from a physician,
chiropractor, nurse, osteopath, physical therapist, dietitian, nutritionist, athletic trainer, or any type of health care provider, the client may
seek such services at any time.” You, as complementary and alternative health care client have the right to file a complaint. To the office
of: Minnesota Department of Health, Health Occupations Program, Susan Winkelman, P.O. Box 64975, St. Paul MN. 55164 Phone 651282-6366.
Holistic Services for Individual Therapy
T.L.C. Transformational Life Coaching:
Short-term solution based therapy and coaching, making it easier and more comfortable to heal the past,
empower the present and design the future of your greatest dreams. Together we will bring awareness to the
functions and purpose of the different levels of consciousness, how memories and perceptions change
through time, how working to resolve limiting or conflicting values and beliefs are at the core of all powerful
transformation. If you feel stuck in an area of your life or have destructive emotions, behavior patterns,
addictions, phobias, or physical pain, and some medical conditions, or if you just want to develop a deeper
understanding of who you are mind-body-spirit, then Transformational Life Coaching (which includes NLP,
Hypnotherapy and more) can assist you on your next steps toward a better, healthier, happier you.
In office & over the phone Skype consulting & coaching
Qigong & Reiki Energy Healing:
In Office or Skype: Distance Healing Sessions the possibilities are limitless. In person the practitioner transmits
electro-magnetic waves that resonate to the level that restores cells back to health. Energy medicine is
message healing, information healing. People recover more fully and sooner from surgeries or bone fractures,
fatigue, anxiety, insomnia, carpal tunnel, bursitis, sprains, acute or chronic pain, blood pressure, thyroid
conditions, digestive and elimination issues, dental work, infections, immune system imbalances, degenerative
diseases, arthritis and cancer etc. It can be used for any physical, emotional, mental and spiritual conditions or
concerns. Energy medicine is now accepted as a legitimate healing modality in many hospitals and clinics in the
United States even though for centuries it has been used. Healing energy can be passed through touch and
remotely through long distances. The effects can be subtle or profound. Some clients have noticed the
benefits from just one session. For others the conditions gradually improve with each session. Visit Theresa’s
website “healing stories” pages, for listings of client testimonials, and for more scientific information, IONS
Institute for Noetic Sciences www.noetic.org. Energy medicine is safe for anyone of any age or with any
condition. My training background is in: Qigong healer/teacher, Reiki master/teacher, and Reconnective
healing.
In office & over the phone / Skype Energy healing
Shiatsu - Asian Bodywork Therapy:
Where ever your present health status is shiatsu can always benefit. Shiatsu-Asian bodywork restores the
body’s own ability to renew itself, harmonizing the internal forces that support healthy-functioning organs.
Shiatsu moves the lethargic or stagnant, subdues the excessive and nourishes the depleted. Shiatsu helps
remind the body to create balance and peace within. Asian bodywork is for everyone who needs to address
imbalance from acute to chronic medical conditions or for those of you who just need to undo the stress of
everyday and need self care time for rejuvenating and maintaining great health…. that covers just about
everyone! I do various forms of Shiatsu; Namikoshi, Zen, Anma Shiatsu, Tuina, Jin shin do a very gentle holding
points energy/bodywork, Ampuku Chinese stomach massage, Foot Reflexology, Sooji Hand Therapy, Guasha
deep rubbing dispersing technique, Cupping dispersing technique that pulls toxins out of the body and Moxibustion burning herbs over specific meridian points for warming & tonifying the body. All these therapies are
based on Traditional Chinese Medicine or TCM. Tongue and pulse diagnosis are a part of most treatments. They
are both considered bodywork and energy work because they treat the meridians.
In office or on location
Appointment Office Hours Please call first to schedule your appointment time and office location
preference. Some services are limited by location.
What You Can Expect from these Therapies
Transformational Life Coaching
Hypnotherapy
NLP
Regression Therapy
Short-term solution based therapy and coaching, that makes it easier and more comfortable to; heal the past
become more resourceful in the present and approach your desired future more effortlessly. During your 1st
visit you will gain a better understanding of levels of consciousness, conflicting or incongruent perceptions,
supportive or limiting perceptions; beliefs, values, decisions, and judgments, your consciousness and how it
relates to time and space, inducing emotions and behaviors, how information gets stored and how emotions
and behaviors are responses stemming from present and past strategies or programmed beliefs and values.
We will also discuss and set up communication of the conscious / sub conscious and unconscious mind. Your
2nd visit is about gaining clarity of what you don’t want and discovering what you do want through a 4 step
process that will help you get very clear about the direction you want to move into. The 3rd visit, we’ll begin
doing the change work intervention process. During your first visit you should allow for up to one hour. The
second and third visit you allow for 1 ½ to 2 hours per session. NLP, Regression and Hypnosis are therapies
that do not stop midstream of the change-work process, this allows for you and I to respond to golden
opportunities for learning, growing and finishing a piece of change-work. The maximum time however that is
beneficial to the client is no more than 2 hours. You can expect to learn and grow in ways that you have never
thought of. Determining how many sessions you will need really depends on each person’s depth or breadth
of understanding the issues or how desirable your stated outcome is. I have had clients also experience the
following: more energy and mental clarity, or a healing crisis; where the body responds to the major shift in
consciousness through possible increased need for sleep, detoxification and quantum synchronicity where
things just unexplainably fall into place. The
Individual & Group Coaching Available. In office & over the phone / Skype consulting & coaching
Life Times Hypnosis (Past Life Regression therapy & Life Between Lives)
More and more humanity is waking up to accepting that our life stories haven’t started with our birth into this
body nor ending when the body releases its spirit. I grew up catholic and under the current teachings of the
church there is no such thing as reincarnation, though at the time over 20 years ago, when I posed this
question to my priest, he said “There are books in the bible that were removed regarding reincarnation, and
because of the current church law, I am not able to discuss these with you”, he then smiled in a caring and
encouraging and even a little child-like mischievous manner that caused me to continue to be curious and seek
out my own understanding of the truth. Years later I discovered my own memories through dreams, visions,
flashbacks, déjà vu, and past life regressions. I owe these discoveries to father Arnold Weber who back then in
his own way taught me the meaning of listening to my inner spirits voice and trusting that the creator
continues to expand my understanding of reality outside the confines of societies mores and popular or
unpopular beliefs. Life Times hypnosis is a process that will help you discover many things about yourself and
your-SELF “as soul and as spirit”.
When you look through the lens of who you are from this higher expanded perspective, you can then bring a
deeper level of understanding, compassion and even forgiveness to yourself and to others, AND discover your
life purpose, your own sacred path of awakened choices, and what you came here to accomplish. As with
other hypnotherapy, we start with a session of inquiry, where I will assist you in holding quality questions that
will unlock the most benefit for you. Then if needed subsequent regressions going deeper and deeper into
your abilities to relax into deeper brainwave states from alpha, to theta, to delta or gamma brainwaves.
Everyone has the ability to access these states so through practice you will increase your skills and stay there
longer to access more information and accomplish more. Please allow for 2 – 3 visits to achieve these goals.
Shiatsu Asian Bodywork Therapy & TCM Traditional Chinese Medical assessments
Shiatsu is a type of acupressure that is done through clothing so bring comfortable clothing to wear during
your session (i.e.. sweat pants, shorts, long or short sleeve shirt). You should avoid caffeine or eating full meals
a half-hour before the session. For TCM tongue assessment purposes please do not brush your tongue in the
morning. Never drink alcohol before or soon after your treatment. For one-hour appointments know that a
TCM assessment (if needed) will take about 5 – 10 minutes of the beginning of your session. If assessment time
takes longer you will be charged for additional minutes or it will reduce your treatment time further. Be aware
that emotional releasing may occur because of the healing intended nature of these treatments and that this is
very normal. Each process is as unique as each individual. If unprocessed memories or emotions come to the
surface of your consciousness, please feel comfortable with sharing them with me, I am well trained to
facilitate these emotional - spiritual processes. However if you choose to seek a spiritual director or counselor
you may do so at any time. The effects of Shiatsu and other Asian bodywork differ with the intended
treatment. In normal circumstances you can expect to feel more energy, vitality, mental clarity, and a relaxed
peaceful state of mind and body. Common under therapy with a medical condition some may experience a
healing crisis, or a break through where symptoms or detox responses may increase for 24 – 48 hours
following the treatment.
*** Also be aware that if you are on medication that you may need to follow up with a doctors’ visit if you
begin to experience symptoms of being over medicated. If the body begins to heal itself your current dosages
may need to be reduced.
Jin Shin Do, is a very gentle holding meridian points type of work but the energy shifts are typically very deep
which often causes; unusual hunger, drop in body temperature, or tiredness. Rest assured that this will pass
quickly and you will notice improvements. Honor your healing process and be gentle with yourself.
Moxa-bustion is used for tonifying a weak, frail or cold body. It consists of burning herbs over specific
meridian points to strengthen those organ pathways the effects of mild blistering are rare but possible.
Cupping & Guasha is used to remove toxins, stagnant qi/chi or blood from old injuries, external pathogens that
cause colds & flu. The side effects will most likely cause discoloration of the skin from 1 – 7 days.
Qigong & Reiki Energy Healing - in office or remote healing
Through quantum field studies and sciences we understand that our body is 99.9% non-matter or mostly
energy - consciousness, filled with vibrational frequencies that either support or hinder optimal health and
wellbeing. So all energy healing is “message-information-vibrationalhealing”. One may experience immediate
improvements while others may need several sessions of gradual progress and restoration. Some ailments
such as carpal tunnel, tendonitis, stomach pain, may take as little as 1-4 sessions while torn rotator cuff ( 4 – 15
sessions) , depression or anxiety (weeks – months), neuropathy, growing cartilage or bone when missing
completely (months to years), broken bones heal faster than 6 to 10 weeks of normal recovery time. If you
have a condition that has not been mentioned, please ask I will give you my honest and professional opinion.
Healing responses are similar to shiatsu Asian bodywork (so read the above paragraph). You can experience
more energy, mental clarity, and improvements to your health and well-being and it is also possible to
experience a healing crisis which usually occurs close to/ immediately following your session. Again take note
that if this happens it is a very good sign that your condition will improve very quickly! Also if you are on any
medication currently, I would advise scheduling a visit following our sessions with your physician to ensure the
proper dosages.
In office, email, phone & Skype are available.
*This is a professional ethical practice. I will refer clients to other professionals when I feel
a condition requires a broader scope of knowledge than what I have been trained for. I also do consult with
colleagues that are in similar professions to better assist my clients. You as the client may request referrals at
any time. You also have the right (as I do as well) to end a session early if you feel uncomfortable or unsafe in
any way. Client records are kept. Confidentiality is protected and cannot be shared unless I have written
approval from you or otherwise provided by law.
Payment Policy
Payment is required upon receipt of services or unless otherwise mutually agreed upon. Prepayment maybe
required until the client/practitioner relationship is fully established. Sorry payment plans or reduced fees are
no longer offered. I currently accept Cash, Check, Pay Pal, Credit Card payments in full. Also, I will accept auto
injury insurance arrangements with your authorized physician, adequate paperwork. These client services
needing to be billed to third party payers will be charged $1.75 per minute for services with additional office
clerical, or administrative charges after the first 30 days.
***Cancelations or No Shows*** Clients will be billed at 50% to full price of your reserved scheduled time. This
decision will be made at Heaven On Earth Healing’s discretion. So please make every effort to keep your
appointment or call within 24 to 48 hours in advance. Thank you for honoring my time, talent and service!
Fees for Services are as follows:
T.L.C. Transformational Life Coaching, Hypnosis, NLP, Regression & Life Times Hypnosis
Individual hourly rate
$90
Group rates per series
(determined by location)
Distance Healing Sessions via Skype, phone, email
Initial or occasional one hour session
$80
Weekly or biweekly ongoing
$65
In cases of low income I will offer lower rates based on each persons situation.
Medical Intuitive & TCM Traditional Chinese Medical Assessments
30 minutes
$40
Shiatsu Bodywork, Reflexology Reiki/Qigong Energy-work
15 minute
$30
30 minute
$45
60 minute
$80
75 minute
$95
90 minute
$120
2 hour
$160
In Home Shiatsu
60 minutes
$100
90 minutes
$150
In Home Group Rate
Must have a 4- 6 hours of appointments confirmed for these special group rates
Schedule: family, friends, neighbors, and your “book club group” in your home
60 minutes
$88
90 minutes
$133
2 hours
$180
MN State Sales Tax may be included or an additional cost for Bodywork & Energy healing appointments on a per contract/agreement basis.
Price changes are made up to date on website and current forms and are available upon request.
The State of Minnesota states:
You have the right: to complete and current information concerning the practitioner’s assessment and recommended service. Expect
courteous treatment and to be free of verbal, physical or sexual abuse by the practitioner. Access to records and written information from
records in accordance to sec. 144.335 To be informed that there are other health care services available in the community and can be
found on community boards in stores, or newspapers and the yellow pages. To choose freely among available practitioners at any time
with in the limits of health insurance, medical assistance or other provider services. To refuse services or treatment unless otherwise
provided by law. To assert your rights without retaliation. The practitioner also has the right to be free from verbal, physical or sexual
abuse And can end the session and charge normal fee for that appointment time.
Cut on this dotted line and retain the above information for your records
This portion is for your file
I, (please print name)____________________________ have received and read the complementary &
alternative health care client bill of rights. And, I have been informed on what to expect during and after I
receive Asian Bodywork, Qigong/Reiki healing, Transformational Life Coaching, NLP, and Hypnotherapy and
understand that this holistic therapy is in no way intended to replace conventional allopathic medicine.
Signature___________________________________________Today’s DATE__________
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